不同类型胸大肌皮瓣修复颅颌面缺损

目的研究不同类型胸大肌皮瓣修复不同部位和类型颅颌面缺损的临床效果。方法传统的带蒂胸大肌皮瓣修复颊、面下部、舌、口底等部位缺损354例;带蒂双叶胸大肌皮瓣修复面颊部洞穿性缺损7例;带蒂肋骨胸大肌皮瓣修复舌、口底、下颌骨复合性缺损2例;带蒂胸大肌筋膜瓣修复舌、口底缺损15例;游离胸大肌皮瓣修复颅底、上颌骨、颧面部缺损4例,胸肩峰动静脉分别与颌外动脉、颈外静脉或面总静脉吻合。结果带蒂胸大肌皮瓣完全成活338例,3例完全坏死,4例部份坏死。带蒂双叶胸大肌皮瓣6例完全成活,1例完全坏死。带蒂肋骨胸大肌皮瓣及游离胸大肌皮瓣全部成活。带蒂胸大肌筋膜瓣完全成活,肌瓣表面在术后3~4个月出现黏膜化,但其中2例肌瓣表面在术后3个月时仍有大量肉芽组织增生,彻底清创后方黏膜化。结论不同部位、不同类型的组织缺损应选用不同种类的胸大肌皮瓣修复,其操作简便、成功率高,扩大了适应证。

Reconstruction of craniomaxillofacial defects with different type major myocutaneous flaps

Objective To study the clinical effects of different type major myocutaneous flaps in the reconstruction of craniomaxillofacial defects. Methods From 1984 to 2007,382 patients with craniomaxiflofacial defects were reconstructed use difference type major myocntaneous flaps. The flaps included pectoralis major myocutaneous flaps（354 cases）, double leaf major myocutaneous flaps（7 cases）, pectoralis rib-major myocutaneous flaps（2 cases）, pectoralis major myocutaneous fascia flaps（ 15 cases）and free major myocutaneous flaps（4 cases）. Results 374 different type major myocutaneous flaps survived and the wound healed up well. Only 4 flaps were necrosis and 4 flaps partial necrosis. The surface of the pectoralis major myocutaneous fascia flaps could memorize after 2 - 3 months. Conclusion The reconstruction of different craniomaxiUofacial defective type and region should choose different major myocutaneou flaps type.