带血管蒂肌皮瓣在头颈外科修复中的应用  

Clinical study of four kinds of myocutaneous flaps with vessel for reconstruction in head and neck surgery

作　　者：赵晓明[1] 黄健男 熊国军[1] 窦晓晖[1] 李小敏[1] 

机构地区：[1]暨南大学医学院第三附属医院耳鼻咽喉科,广东珠海519000 [2]广东省177医院耳鼻咽喉科,广东广州510317

出　　处：《中国耳鼻咽喉颅底外科杂志》2004年第4期230-232,共3页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的　探讨带血管蒂肌皮瓣在修复头颈肿瘤切除术后组织缺损的方法和适应症 ,提高病人生活质量。方法　采用额瓣、舌骨下肌皮瓣、斜方肌皮瓣、胸大肌皮瓣等四种带血管蒂肌皮瓣 ,为 31例头颈肿瘤切除术后病人的大片缺损 ,实行一期整复与重建。结果　 31例中 1例 (3.2 % )肌皮瓣全层坏死 ;3例 (9.7% )皮岛皮肤部分坏死 ,但肌层存活 ,换药后自愈 ;肌蒂下血肿 3例 (9.7% ) ;深部感染 4例 (12 .9% )。本组病例Ⅰ期成活率 87.1% (2 7/31) ,Ⅱ期成活率 9.7% (3/ 31)。 30例重建术后行 4 0Gy～ 70Gy放疗 ,未见肌皮瓣坏死、伤口裂开等并发症发生。 2 6例随诊 6个月以上 ,术后 3～ 5个月肌皮瓣均有轻度萎缩 ,其中胸大肌皮瓣肌蒂萎缩较明显 ,外表颜色接近正常 ,腔内皮瓣衬里逐渐黏膜化发展。 18例追踪 3年以上局部功能和形态均有较大改善。结论　 4种带血管蒂肌皮瓣制作简便 ,成功率高 ,效果满意 ,具有良好的抗感染力和放疗耐受力 ,临床应用主要根据肿瘤部位。Objective To discuss the methods and indications of using myocutanous flaps with vessel to reconstruct the large defect that results from the resection of head and neck cancer. Methods To use four kinds of myocutaneous flaps with vessel: - forehead, infrahyoid, trapezius, and pectoralis major myocutaneous flaps, for repairing and reconstructing the large defects in 31 caces with carcinoma of head and neck at the same stage. Results Of the 31 cases, myocutaneous flaps fully survived in 27 cases ((87.1%)), all layer necrosis in 1 case ((3.2%)), partial necrosis of skin island with the muscular layer alive in 3 cases ((9.7%)), haematoma in 3 cases ((9.7%)), and infection in 4 cases ((12.9%)). Ⅰ stage and Ⅱ stage survival rates were (87.1%) (27/31) and (9.7%) (3/31), respectively. Thirty cases were radiated with 40 Gy～70 Gy after reconstructing operation and no compication of myocutaneou flap necrosis and fission occuvred. Conclusion It is simple and convenient, with higher success rate and satisfactory efficiency to use the four flaps, which shows excellent ability against infection and radiation. It is important to choose projects according to tumor region and defect range.

关 键 词：头颈部肿瘤/外科学 带血管蒂肌皮瓣 手术重建 

分 类 号：R739.91[医药卫生—肿瘤] R622.1[医药卫生—临床医学]