胸大肌皮瓣修复口腔颌面部大型缺损的临床体会  

Clinical experience of repairing large maxillofacial defects with pectoralis major myocutaneous flap

作　　者：张学伟[1] 国美丽 王志兴[2] 沈军[1] 张建成[1] 张军[1] 穆杰[1] 严颖彬[1] ZHANG Xuewei;GUO Meili;WANG Zhixing;SHEN Jun;ZHANG Jiancheng;ZHANG Jun;MU Jie;YAN Yingbin(Department of Oral and Maxillofacial Surgery, Tianjin Stomatological Hospital, Tianjin 300041, China;Department of Stomatology, Tianjin Fifth Central Hospital)

机构地区：[1]天津市口腔医院口腔颌面外科,300041 [2]天津市第五中心医院口腔科

出　　处：《天津医药》2016年第8期1026-1028,1062,共3页Tianjin Medical Journal

基　　金：天津市自然科学青年基金资助项目(14JCQNJC12500);天津市卫生局面上项目(2012KY18)

摘　　要：目的探讨胸大肌皮瓣修复口腔颌面部恶性肿瘤术后大型缺损的临床效果。方法 27例口腔颌面部恶性肿瘤患者术后缺损采用胸大肌皮瓣修复,皮瓣切取大小为6 cm×4 cm^11 cm×9 cm。26例修复口内缺损,1例修复面部缺损。17例经锁骨上、10例穿锁骨下进入颈部。结果术后20例完全成活(74.1%),6例部分坏死(22.2%),1例完全坏死(3.7%)。13例出现术后并发症(48.1%):10例(37.0%)为伤口感染,其中受区感染8例,供区感染2例,7例皮瓣坏死的患者均出现受区伤口感染;其他并发症包括伤口裂开、颈部血肿及肺感染各1例(3.7%)。结论为避免皮瓣坏死及减少受区伤口感染,应按照胸大肌皮瓣的血供特点设计皮瓣并保护好血管蒂。Objective To summarize the clinical outcomes of pectoralis major myocutaneous flap for repairing large defects in oral and maxillofacial area after resection of malignant tumor. Methods The clinical data of 27 patients underwent resection of malignant tumor in oral and maxillofacial area and reconstructed with pectoralis major myocutaneous flap were collected in our hospital from August 1998 to January 2015. The pectoralis major myocutaneous flaps were harvested with sizes ranging from 6 cm×4 cm to 11 cm×9 cm. The major myocutaneous flaps were used to reconstruct the defects of oral mucosa in 26 cases, and flap was used to reconstruct the defect of facial skin in 1 case. Seventeen major myocutaneous flaps reached the neck via the subclavicular tunnel, the other 10 were transferred over the clavicle. Results After surgery, 20 flaps (74.1%) were survived completely, 6 were partial necrosis (22.2%) and one was total necrosis (3.7%).Thirteen cases showed postoperative complications (48.1%), in which 10 cases were wound infection (37.0%), including 8 patients with infection at the recipient site and 2 patients with infection at the donor site. The wound infection was found in all of 7 patients with flap necrosis. The other complications included wound dehiscence in 1 patient (3.7%), neck hematoma in 1 patient (3.7%), and lung infection in 1 patient (3.7%). Conclusion In order to avoid the flap necrosis and reduce wound infection at the recipient site, the major myocutaneous flap should be designed based on the characteristics of blood supply, and the vascular pedicle should be protected carefully in the operation.

关 键 词：手术后并发症 修复外科手术 胸大肌皮瓣 坏死 口腔颌面部肿瘤 缺损 

分 类 号：R782.2[医药卫生—口腔医学]