胸大肌瓣加原位皮片移植修复鼻咽癌放疗后颈部复发的术后缺损  

Pectoralis major myocutaneous flap plus in situ skin graft for reconstruction of neck defects in irradiated nasopharynx carcinoma patients

作　　者：李铨[1] 温清泉[1] 廖卫国[1] 漆其光[1] 吴迪[2] 张欣睿[2] 刘志民[2] 刘学奎[2] 

机构地区：[1]广州医科大学附属肿瘤医院头颈科,广东广州510095 [2]中山大学肿瘤防治中心头颈科,华南肿瘤学国家重点实验室,广东广州510060

出　　处：《现代肿瘤医学》2014年第5期1045-1048,共4页Journal of Modern Oncology

摘　　要：目的:胸大肌皮瓣是头颈部术后缺损常用的修复皮瓣,但由于它的臃肿常导致术后较高的并发症发生。本文将介绍我院采用胸大肌皮瓣去脂、原位皮片植皮在鼻咽癌放疗后颈部复发术后皮肤缺损修复中的应用。方法:对2007年1月-2012年1月就诊中山大学肿瘤防治中心的8例鼻咽癌根治性放疗后颈部复发侵犯颈部皮肤及皮下组织患者,采用胸大肌皮瓣去脂、原位皮片植皮修复颈部大面积皮肤及皮下组织缺损。常规取胸大肌皮瓣,切除皮瓣的皮肤及皮下脂肪,从切除的皮肤中获取表皮和真皮层植皮在胸大肌上,打包7天。结果:皮瓣大小6cm×9cm-6cm×15cm,常规测量切除的皮下脂肪厚度,平均15.13mm(n=8)。所有皮瓣及移植皮片均存活良好,所有患者对术后供区、受区外观满意。结论:本方法简便易行,创伤小,成活率高,改善胸大肌皮瓣臃肿的同时修复了颈部皮肤缺损,不仅能恢复功能,还有较好的外形。Objective：The Pectoralis major myocutaneous flaP（PMMF）is a commonly used flaP in reconstructive head and neck surgery,but in literature,the flaP is also associated with a high incidence of comPlications due to its large bulk. The aim of the current study was to introduce PMMF Plus in situ skin graft for reconstruction of neck de-fects in irradiated nasoPharynx carcinoma Patients. Methods：From January 2007 to January 2012,8 debulking Proce-dures were Performed on 8 Patients who had received reconstruction with PMMF for defect of the neck. All Patients have recurrent nasoPharynx carcinoma after radical radiotheraPy with clinically PalPable cervical lymPh node metasta-ses and metastatic dePosits involving the neck skin and the underlying soft tissues. The ePidermis and most of the der-mis were harvested from the flaP,regrafted on the defatted flaP and fixed with tie - over dressing for 7 days. Results：The areas of flaP size ranged from 6cm × 9cm to 6cm × 15cm. The average thickness of removed fat was 15. 13mm（n= 8）. All the grafted skin and PMMF took well. All Patients were satisfied with aesthetic result of the donor site and the receiving site after surgery. Conclusion：This method can Provide strict thin skin coverage for the neck after PMMF reconstruction to achieve good functional and esthetic requirements.

关 键 词：胸大肌皮瓣 原位皮片移植 颈部缺损 去脂程序 鼻咽癌 

分 类 号：R730.7[医药卫生—肿瘤] R739.63[医药卫生—临床医学]