胸大肌皮瓣.docVIP

改良胸大肌肌皮瓣在修复头颈肿瘤术后缺损的疗效观察 彭正加* 朱同林 廖俊 刘彬 江殿立 （湖南省湘潭市中心医院耳鼻喉－头颈外科，湖南 湘潭 410000） 摘要:目的 总结改良胸大肌肌皮瓣修复头颈肿瘤手术组织缺损的临床疗效。方法　回顾性地总结我科2004年6月1日～2008年6月31日间，15例应用改良胸大肌肌皮瓣修复头颈肿瘤手术巨大组织缺损，其中12例经锁骨下隧道转移。手术均为Ⅰ期修复，皮瓣面积为5cm×6cm～10cm×15cm。结果 肌皮瓣全部成活，2例发生咽瘘， 1例肌皮瓣远端部分坏死，均经换药后愈合。结论　胸大肌肌皮瓣具有丰富的血液供应，优良的组织量，修复操作简单，应用广泛，特别适用于头颈部肿瘤扩大切除术后巨大组织缺损的修复，我们通过保留上1/3-1/2胸大肌及锁骨下隧道转移改良，充分发挥了胸大肌肌皮瓣的优越性。 关键词: 改良胸大肌肌皮瓣；修复；头颈肿瘤 Efficacy Observation on Repair of Tissue Defects in Head and Neck Tumors with Pectoralis Major Myocutaneous Flap Abstract Objective：Summary the clinical efficacy on repair of tissue defects in head and neck tumors with modified pectoralis major myocutaneous flap. Method：A retrospective summary of 15 cases of application of modified pectoralis major muscle flap for head and neck tumors large tissue defect in our department between June 1, 2006 to January 31, 2010.(12 cases transfer via subclavicular pedicle ).All the operation wereⅠ-stage repair surgery.The size of flaps ranged from 5cm×6cm to 10cm×15cm. Result：Muscle flaps all survived in 12 cases, 2 cases of pharyngocutaneous fistula occurred. 1 cases of distal part of the muscle flap necrosis occurred.These cases were healed by changing dressing. Conclusion：Pectoralis major muscle flap.has rich blood supply, excellent organizational capacity, simple operating so that it can be applied in many cases，especially for repair of tissue defects in head and neck tumor .We made full use of advantage of pectoralis major myocutaneous flap by retain upper 1/3-1/2 pectoralis major and transfer of subclavicular pedicle. Keywords: Pectoralis Major Myocutaneous Flap; Repair; Head and Neck Tumor 晚期头颈部肿瘤外科治疗经常需要扩大切除，手术切除后留下的巨大组织缺损，常常给局部的整形与重建带来难题。术后缺损的即刻修复可以提供良好的整形和保留较好的功能，使患者更愿意接受这些扩大切除手术来提高生存的机会和质量。1979 年Aryian[1]首次报告胸大肌肌皮瓣(pectoralis major myocutaneous flap , PMMC)，胸大肌肌皮瓣以其优越可靠的特点，在组织缺损修复中发挥了重要作用，几乎可以不受限制地应用于头颈部任何部位的整形与重建，迅速成为临床主要的修复头颈部肿瘤术后组织缺损的方法之一[2]。但标准术式存在同侧胸大肌功能障碍、颈部臃肿及蒂短等缺点[3]。应用保留胸肌功能及锁骨下隧道转移的改良胸大肌肌皮瓣Ⅰ期修复头颈部肿瘤术后组织缺损，可能是一种较好的解决