劈裂式双岛胸大肌皮瓣修复复发性口腔癌切除术后口内及颈部缺损  

BIPADDLED SPLIT PECTORALIS MAJOR MYOCUTANEOUS FLAPS FOR IMMEDIATE RECONSTRUCTION OF ORAL MUCOSAL DEFECTS AND NECK DEFECTS AFTER RESECTION OF RECURRENT ORAL CANCER

作　　者：陈洁[1] 蒋灿华[1] 李宁[1] 高政阳 陈立纯[2] 吴晓珊[1] 陈新群[1] 翦新春[1] 

机构地区：[1]中南大学湘雅医院口腔颌面外科,长沙410008 [2]中南大学湘雅医院手术室,长沙410008

出　　处：《中国修复重建外科杂志》2015年第7期793-798,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨劈裂式双岛胸大肌皮瓣在复发性口腔癌切除术后口内及颈部缺损修复中的应用价值。方法 2013年9月-2014年9月,收治6例复发性口腔癌患者。男5例,女1例;年龄45~62岁,平均54.7岁。舌癌术后复发4例,下颌牙龈癌及口底癌术后复发各1例。所有患者均为原位局部复发且复发间隔为8~14个月,无肺、肝等远处转移。术中彻底切除复发病灶后,遗留口内缺损4.0 cm×2.5 cm^6.5 cm×3.5 cm,颈部缺损5.5 cm×3.5 cm^7.5 cm×5.0 cm。切取大小为14.0 cm×3.5 cm^17.0 cm×5.5 cm的胸大肌皮瓣,自第3~4肋水平顺胸大肌肌纤维方向劈开至距离胸肩峰血管束约2 cm处,形成具有独立双皮岛的胸大肌皮瓣,其中远端皮岛修复口内缺损,近端皮岛修复颈部缺损。胸部供区直接拉拢缝合。结果术后1例出现颈部血肿,1例颈部感染,经对症处理后愈合;6例胸大肌皮瓣共12个皮岛均成活,切口均Ⅰ期愈合。患者术后均获随访,随访时间6~18个月,平均11个月。1例术后8个月死于肺部转移,余5例随访期间未见复发和远处转移。所有患者口内皮瓣形态良好,语音、吞咽功能恢复满意,颈部外形丰满,运动自如,颌下及颈部无瘘管形成。结论劈裂式胸大肌皮瓣能同时修复口内黏膜和颈部皮肤缺损,在复发性口腔癌根治术后缺损修复中具有应用价值。Objective To investigate the feasibility of the bipaddled split pectoralis major myocutaneous flap for immediate reconstruction of oral mucosal defects and neck defects after resection of recurrent oral cancer. Methods Six patients with oral mucosal defects combined with neck defects after recurrent oral cancer resection were treated with bipaddled split pectoralis major myocutaneous flap between September 2013 and September 2014. There were 5 males and 1 female with an average age of 54.7 years（range, 45-62 years）, including 4 cases of recurrent tongue cancer, 1 case of recurrent mandibular gingival cancer, and 1 case of mouth floor carcinoma. All patients underwent local recurrence at8 to 14 months after first operation, with no distant metastasis. The defects of the intraoral mucosa was 4.0 cm×2.5 cm to6.5 cm×3.5 cm and the defect of the neck skin was 5.5 cm×3.5 cm to 7.5 cm×5.0 cm. The pectoralis major myocutaneous flaps（14.0 cm×3.5 cm to 17.0 cm×5.5 cm） were incised at the level of the 3rd to the 4th rib, and then split down along the muscle fiber till about 2 cm away from the thoracoacromial vessels, forming 2 independent skin paddles with1-2 branch vessels to the pedicles of the distal ones. The distal skin paddles were used for oral reconstruction while the proximal paddles for repair of neck defects. The chest donor sites were sutured directly. Results Cervical haematoma and infection happened in 1 patient respectively after operation, and were cured after symptomatic treatment. All6 split pectoralis major myocutaneous flaps with 12 skin paddles completely survived. All patients were followed up 6 to 18 months（mean, 11 months）. One patient died of pulmonary metastasis at 8 months after operation and the other5 survived without relapse or metastasis during follow-up. The intraoral paddles showed good shape with satisfactory speech function and swallowing recovery. The paddles also healed perfectly on the neck with flat outlooks, and all patients obtained full appearance and free movement

关 键 词：劈裂式胸大肌皮瓣 复发性口腔癌 缺损修复 局部皮瓣 

分 类 号：R739.8[医药卫生—肿瘤]