垂直斜方肌肌皮瓣修复头颈部肿瘤切除术后软组织缺损  

VERTICAL TRAPEZIUS MYOCUTANEOUS FLAP FOR REPAIRING SOFT TISSUE DEFECT AFTER HEAD AND NECK TUMOR RESECTION

作　　者：王军[1] 马世红[1] 宋一丁[1] 范向达[1] 安宁[1] 

机构地区：[1]甘肃省肿瘤医院头颈外科,兰州730050

出　　处：《中国修复重建外科杂志》2011年第5期554-557,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：甘肃省科技支撑计划项目(0708NKCA108)~~

摘　　要：目的介绍应用垂直斜方肌肌皮瓣同期修复头颈部肿瘤切除术后软组织缺损的临床经验。方法 2008年6月-2010年2月,采用垂直斜方肌肌皮瓣同期修复头颈部肿瘤切除术后软组织缺损12例。其中男9例,女3例;年龄32～76岁,中位年龄54岁。眼眶区基底细胞癌2例,腮腺鳞状细胞癌侵及皮肤2例,颌下腺恶性混合瘤2例,鼻咽癌放疗后颈部淋巴结转移2例,舌鳞状细胞癌1例,枕部皮肤鳞状细胞癌3例。患者肿瘤TNM分期均为T3或T4病变。肿瘤切除术后软组织缺损范围13 cm×6 cm～25 cm×13 cm,采用大小为14 cm×7 cm～26 cm×14 cm的垂直斜方肌肌皮瓣修复缺损。供区直接拉拢缝合。结果术后切口均Ⅰ期愈合,无感染等并发症发生。11例肌皮瓣全部成活,1例术后10 d肌皮瓣边缘坏死,经换药后延期愈合。2例术后7 d拔除引流后1周内背部供区出现少量皮下积血、积液,经抽吸加压包扎后皮瓣愈合。11例患者术后获随访,随访时间1～3年,平均2年。9例患者随访期内未见肿瘤复发,肌皮瓣外形满意,双肩外展功能良好;术后3个月1例眼眶区基底细胞癌复发;1例鼻咽癌患者术后12个月死于脑转移。结论垂直斜方肌肌皮瓣手术操作简便,组织瓣有足够长度,血供丰富,可满足头颈部软组织缺损的修复。Objective To introduce the experience of the clinical application of vertical trapezius myocutaneous flap in repairing soft tissue defects after head and neck tumor resection.Methods Between June 2008 and February 2010,12 cases of soft tissue defect caused by head and neck tumor resection were repaired with vertical trapezius myocutaneous flap.There were 9 males and 3 females with an age range from 32 to 76 years（median,54 years）.Twelve cases including 2 cases of basal cell carcinoma of orbital skin,2 cases of squamous cell carcinoma of the parotid gland,2 cases of submandibular gland malignant mixed tumor,2 cases of metastatic lymph nodes of nasopharyngea carcinoma after radiotherapy,1 case of squamous cell carcinoma of tongue,and 3 cases of squamous cell carcinoma of occipital skin,and all were classified as TNM stages T3 or T4.The area of soft tissue defect ranged from 13 cm×6 cm to 25 cm×13 cm.The vertical trapezius myocutaneous flap ranged from 14 cm×7 cm to 26 cm×14 cm and was transfered to repair defect tissue in the homolateral wounds after tumor resection and neck dissection homochronously.The donor sites were sutured directly.Results All incisions healed primarily without infection.Eleven flaps survived except 1 flap with edge necrosis,which was cured after dressing change.Subcutaneous hematocele and effusion occurred in 2 cases on the back after tube was removed at 7 days postoperatively,and they were cured by sucted and pressured dressing.Eleven patients were followed up 1-3 years（mean,2 years）.Nine cases had no tumor recurrence and the flaps had statisfactory appearance;the abduction function of shoulder joint were normal.One case of orbit basal cell carcinoma occurred 3 months after operation and 1 case of nasopharyngeal carcinoma died of brain metastasis 12 months after operation.Conclusion It is an easy and simple therapy to repair head and neck soft tissue defect using the vertical trapezius myocutaneous flap,which can meet the needs of repairing tissue defect of head and neck.

关 键 词：垂直斜方肌肌皮瓣 头颈部肿瘤 软组织缺损 修复 

分 类 号：R739.91[医药卫生—肿瘤]