锁骨上岛状皮瓣在头颈部肿瘤手术缺损修复中的应用分析

目的　探讨锁骨上岛状皮瓣在头颈部肿瘤术后缺损修复中的临床应用。方法　回顾性分析2018年12月~2022年3月中国科学院大学附属肿瘤医院头颈外科应用锁骨上岛状皮瓣修复头颈部肿瘤术后缺损32例患者的病例资料,其中修复下咽11例、气管8例、头颈部皮肤6例、喉部3例、口腔2例、食管1例及咽瘘1例。制备皮岛大小约（3～7）cm×（3～10）cm,皮瓣蒂部的长度约10～20 cm。记录皮瓣存活情况、受区及供区其他并发症情况。结果　32例患者中30例皮瓣全部存活,2例皮岛局部坏死。并发咽瘘6例（皮瓣均 存活）。肩部供区皮肤均直接拉拢缝合,无切口感染、肩部功能损伤等并发症。结论　锁骨上岛状皮瓣修复头颈部肿瘤术后缺损疗效可靠,适用范围较广,有较好的应用前景。     

游离上臂外侧皮瓣修复舌癌术后软组织缺损的临床应用

目的 探讨游离上臂外侧皮瓣一期修复舌癌术后软组织缺损的临床应用。方法 选取2019年6月—2021年9月舌癌根治术的32例患者，应用游离上臂外侧皮瓣同期行舌缺损修复。其中男25例，女7例，病理类型均为鳞状细胞癌。术前多普勒血流探测仪确定上臂外侧区域穿支血管位置，皮瓣轴线位于三角肌止点与肱骨外上髁之间的连线后方1 cm，根据舌缺损面积和形状设计皮瓣。结果 32例患者中，皮瓣大小为7.5 cm×4.0 cm~14.0 cm×6.0 cm，平均厚度为（0.85±0.40） cm，平均血管蒂长度为（8.24±1.37） cm，穿支数量为2~4支。供区切口均一期拉拢缝合。除1例患者术后第4天皮瓣坏死改股前外侧皮瓣修复后皮瓣存活，皮瓣一期成活率为96.9%（31/32）。所有患者术后均未行气管切开。随访7~22个月，平均11个月，患者术后外形及功能恢复较满意，无远期并发症。结论 游离上臂外侧皮瓣血管恒定、制备简单、质地薄软，皮瓣成活率高，供区并发症少，是修复舌癌术后半舌缺损的良好选择。     

带蒂胸大肌皮瓣在头颈部肿瘤术后缺损修复中的应用

目的:探讨运用带蒂胸大肌皮瓣修复头颈部肿瘤切除术后缺损的效果及优点。方法:13例晚期头颈部肿瘤患者,行肿瘤切除术后以带蒂胸大肌皮瓣修复术后缺损。结果:术后11例愈合良好;1例出现腮腺瘘,加压包扎后愈合;1例自动出院后失访。结论:胸大肌皮瓣修复头颈部肿瘤切除术后缺损,具有血供丰富、可修复较大面积缺损、术后愈合较好等优点。对延长患者生命,减轻病痛有重要作用。     

鼻翼恶性肿瘤切除并鼻唇沟带蒂皮瓣Ⅰ期修复11例疗效分析

目的:探讨鼻唇沟带蒂皮瓣在修复鼻翼恶性肿瘤术后缺损的临床实用性和可行性。方法:对11例鼻翼恶性肿瘤患者行手术切除肿瘤,并根据鼻唇沟面部血供特点及缺损区大小设计出需要修复区域的长度、角度和体积,设计鼻唇沟面部带蒂皮瓣。经鼻侧移至缺损区修复鼻翼缺损区。结果:所有患者术后伤口均Ⅰ期愈合,皮瓣全部成活,血液循环良好,色泽良好,供区无明显瘢痕。术后随访1～5年,肿瘤无复发,外鼻美容修复效果满意。结论:鼻唇沟带蒂皮瓣血运丰富,易成活,可提供足够的组织量用以修复较大面积鼻翼缺损,且血管蒂长,转移灵活,操作简便,供区无明显瘢痕。鼻唇沟带蒂皮瓣是修复鼻翼恶性肿瘤切除术后较大面积缺损的最佳皮瓣。     

锁骨上皮瓣在喉咽癌术后缺损修复中的应用

目的研究锁骨上皮瓣在喉咽癌术后缺损修复中的临床应用。方法回顾性分析2017年7月~2019年1月中山大学肿瘤防治中心应用带蒂锁骨上皮瓣修复喉咽癌术后缺损5例患者的临床资料,取带蒂锁骨上皮瓣修复缺损,皮瓣面积(6~20) cm×(4～6.5) cm。记录皮瓣制备时间、术中总出血量、术后引流管放置时间、皮瓣存活情况及供区愈合情况等。结果所有患者术中皮瓣制备时间平均为30 min（25～35 min）,术中总出血量平均为56 ml（50~80 ml）,术后引流管留置天数平均为6.6 d（5~10 d）。5例患者的锁骨上皮瓣均存活,无一例坏死。供区缺损均直接拉拢缝合,无伤口感染及功能损伤等并发症。结论锁骨上皮瓣具有制备技术简便,修复缺损可靠,伤口美观,局部功能损伤少,无需显微血管吻合等优点,可用于喉咽癌缺损修复手术。     

游离股动脉蒂穿支皮瓣在口颊癌术后缺损修复中的临床应用

目的 探讨游离股动脉穿支皮瓣的临床解剖及其在口颊癌术后缺损修复中的应用。方法 2015年12月—2019年6月选取接受了游离股动脉穿支皮瓣颊修复术男性口颊癌患者13例,年龄37~61岁,平均48.5岁。病理类型为鳞状细胞癌。据TNM分期其中T4N0M0 5例,T4N1M0 2例,T3N1M0 2例,T3N2M0 4例。病程3~16个月,平均9.8个月。游离股动脉穿支皮瓣的具体选择形式包括：①单纯穿支皮瓣7例;②穿支嵌合体肌皮瓣6例。结果 术中皮瓣大小规划范围在6.5 cm×4.0 cm～10.0 cm×6.5 cm,厚度为2.5～3.5 cm。股动脉穿支血管蒂长为（6.2±0.4） cm,供区聚拢闭合缝合。13例皮瓣均成活,供受区一期愈合。随访患者12～30个月,平均21.3个月。重建的口腔外观无肿胀偏移,外形美观,功能良好。供区余轻微瘢痕,肌肉功能良好。结论 游离股动脉穿支皮瓣可用于修复口颊癌根治术后局部缺损。     

带蒂胸锁乳突肌锁骨骨膜皮瓣修复喉气管缺损的初步研究

目的:探讨带蒂胸锁乳突肌锁骨骨膜皮瓣修复肿瘤切除术后喉气管缺损的可行性。方法:回顾2007-2013年6例因甲状腺乳头状癌(4例)及声门下喉鳞状细胞癌(6例)(T1~2N1~2M0,UICC,2002)手术切除致喉气管部分缺损病例,以带蒂胸锁乳突肌锁骨骨膜皮瓣修复喉气管缺损区,术腔置喉模支撑成形,术后半年,如局部无复发,气管套管堵管无困难,则拔管封闭气管造瘘口。随访半年~3年。结果:6例患者中4例顺利拔管,1例间断堵管,1例保留气管套管呼吸。结论:选择适当病例,用带蒂胸锁乳突肌锁骨骨膜皮瓣可以修复喉气管部分缺损,在发音和呼吸方面达到满意的临床效果。     

锁骨上皮瓣在头颈修复中的应用及进展

头颈部手术的术后缺损修复是头颈外科医师面临的难点,目前应用于缺损修复的皮瓣很多,包括局部皮瓣、带蒂组织瓣及游离组织瓣,各种皮瓣均有其优缺点.锁骨上区是一个重要的皮瓣供区,其临近头颈部并且皮肤质地与头颈部相似,目前成为头颈修复皮瓣研究的热点,被越来越多的头颈外科医师应用并推崇.本文对锁骨上皮瓣在头颈修复中的应用进展做一综述.     

锁骨上皮瓣修复头颈缺损9例临床分析

目的　探讨锁骨上皮瓣在头颈肿瘤缺损修复中的应用。方法　回顾性分析2017年1月~2020年12月于扬州大学附属苏北人民医院收治的应用锁骨上皮瓣修复头颈缺损的9例患者临床资料,通过研究其头颈肿瘤缺损的原因、术前放疗史、手术方式、皮瓣尺寸及术后愈合情况等因素,探讨锁骨上皮瓣的制备技巧、应用指征及术后并发症的处理。结果　9例患者均为男性,年龄51~79岁。3例一期修复包括1例下咽癌,1例舌根恶性肿瘤,1例鼻咽癌继发颈部淋巴结转移癌;6例二期修复包括1例下咽癌术后继发颈部淋巴结转移癌,1例喉癌术后继发气管造瘘口癌,1例喉及食管癌术后吻合口瘘,3例下咽癌术后咽瘘。2例咽瘘患者采用锁骨上皮瓣联合胸大肌皮瓣修复缺损,7例患者单独采用锁骨上皮瓣修复。术中所取锁骨上皮瓣宽度为4~8 cm,长度为6~15 cm。8例术后随访皮瓣存活,1例术后皮瓣坏死,清创换药后愈合。1例下咽癌术后患者皮瓣存活,但食管入口肿瘤复发予以放射性粒子植入,局部未控,术后第11个月死亡。结论　锁骨上皮瓣是喉咽及颈部皮肤术后缺损较为理想的修复组织瓣,技术比较成熟,术中应注意皮瓣血管的保护,治疗效果比较可靠。     

耳后带蒂皮瓣在修复耳甲腔皮肤缺损中的应用

目的介绍耳甲腔皮肤缺损中，应用耳后带蒂皮瓣修复耳甲腔皮肤缺损的方法及术后效果。方法2016年对耳甲腔良性肿物术后耳甲腔缺损的3例女性患者于耳后、乳突区，做一“乒乓球拍样”带蒂皮瓣，于耳廓根部做一隧道，将带蒂皮瓣从耳廓根部隧道穿过之后，覆盖于耳甲腔皮肤缺损处，缝合后加压包扎。结果3例患者耳后切口均Ⅰ期愈合，皮瓣颜色、质地、弹性均良好，耳甲腔外观良好，耳后供区瘢痕几乎难以察觉。结论耳后带蒂皮瓣在修复耳甲腔皮肤缺损中，简单易行，术后疗效佳，无论操作上还是美学上，都符合要求，值得临床推广应用。     

Supraclavicular flap in head and neck reconstruction: experience in 50 consecutive patients

The supraclavicular flap (SCF) is a fasciocutaneous flap used to cover head, oral, and neck region defects after tumor resection. Its main vascular supply is the supraclavicular artery and accompanying veins and it can be harvested as a vascularised pedicled flap. The SCF serves as an excellent outer skin cover as well as a good inner mucosal lining after oral cavity and head-neck tumor resections. The flap has a wide arc of rotation and matches the skin colour and texture of the face and neck. Between March 2006 and March 2011, the pedicled supraclavicular flap was used for reconstruction in 50 consecutive patients after head and neck tumor resections and certain benign conditions in a tertiary university hospital setting. The flaps were tunnelized under the neck skin to cover the external cervicofacial defects or passed medial to the mandible to give an inner epithelial lining after the oral cavity and oropharyngeal tumor excision. Forty-four of the 50 patients had 100% flap survival with excellent wound healing. All the flaps were harvested in less than 1 h. There were four cases of distal tip desquamation and two patients had complete flap necrosis. Distal flap desquamation was observed in SCFs used for resurfacing the external skin defects after oral cavity tumor ablation and needed only conservative treatment measures. Total flap failure was encountered in two patients who had failed in previous chemoradiotherapy for squamous cell cancer of the floor of mouth and tonsil, respectively, and the SCF was used in mucosal defect closure after tumor ablation. The benefits of a pedicled fasciocutaneous supraclavicular flap are clear; it is thin, reliable, easy, and quick to harvest. In head, face and neck reconstructions, it is a good alternative to free fasciocutaneous flaps, regional pedicled myocutaneous flaps, and the deltopectoral flap.     

Utilidad y versatilidad del colgajo en isla de la arteria supraclavicular en reconstrucción de cabeza y cuello

Introduction

The supraclavicular island flap is a rotational pedicled flap and may have some advantages in head and neck reconstruction compared with free-tissue transfer when this kind of reconstruction is not affordable or recommended.

The use of negative pressure wound therapy in the primary setting for high-risk head and neck surgery

BackgroundIn head and neck surgery, dead space is typically managed by transferring a secondary pedicled flap or harvesting a larger composite flap with a muscular component. We demonstrate the novel use of prophylactic negative pressure wound therapy (NPWT) to obliterate dead space and reduce possible communication between the upper aerodigestive tract and the contents of the neck.MethodsWe present a single-institutional case series of five patients with high-risk head and neck cancer treated with NPWT after ablative and reconstructive surgery to eliminate dead space following surgical resection.ResultsAll patients achieved successful wound closure following NPWT, which was applied in the secondary setting to combat infection in one patient and the primary setting to prophylactically eliminate dead space in four patients.ConclusionNPWT can be used to treat unfilled dead space in the primary setting of head and neck ablative and reconstructive surgery and help to avoid wound healing problems as well as the need for secondary flap transfers.     

胸肩峰动脉穿支皮瓣修复颈咽部软组织缺损

目的胸肩峰动脉穿支皮瓣（thoracoacromial artery perforator,TAAP）是近年来应用于颈部和咽部组织缺损的新技术,本文分析使用TAAP修复颈咽部缺损的经验。方法回顾分析2013年5月~2017年4月诊治20例TAAP修复咽瘘、咽部黏膜缺损和颈部皮肤缺损。本组患者年龄48~68岁,平均年龄53岁。下咽癌切除+全喉切除10例,保留喉功能的下咽癌切除7例,颈部皮肤缺损3例。咽部黏膜缺损4.5 cm×3 cm~6.5 cm×5 cm,颈部皮肤缺损5.5 cm×4 cm~8 cm×6 cm,皮瓣大小6 cm×4 cm~8 cm×6 cm。结果18例术后皮瓣成活,供区直接拉拢缝合,没有出现皮瓣坏死,其中15例行下咽黏膜修复的患者,术后2~5周恢复经口进食并行术后放疗,剂量60~67 Gy。另2例术中发现穿支血运障碍,更换成颏下皮瓣修复下咽缺损。随访3~36个月,1例术后14个月出现胸段食管癌,1例术后18个月出现纵膈淋巴结转移,均予以放化疗, 1例术后1年出现颈部淋巴结转移复发予以化疗,余病例无复发。结论胸肩峰动脉穿支皮瓣因为邻近颈部、血管相对恒定、皮瓣薄适用于修复咽部黏膜和颈段食管缺损;胸肩峰动脉为血管蒂的一蒂双岛的TAAP和胸大肌皮瓣同时修复复杂的颈部皮肤和咽部黏膜缺损。胸肩峰动脉穿支皮瓣的穿支细小,穿越锁骨下隧道时穿支区域和血管蒂不能扭曲,发现皮瓣血运异常应及时更换其他修复方法。     

头颈部肿瘤术后大动脉破裂出血的救治

目的 探讨头颈部肿瘤术后颈动脉破裂出血的救治及预防.方法 回顾性分析解放军总医院耳鼻咽喉头颈外科2003年10月至2009年8月对7例头颈部肿瘤患者术后颈部大动脉破裂采取的X线介入栓塞和介入内置覆膜支架的救治.7例患者中6例系颈总动脉破裂,1例为颈内动脉破裂.全部患者于肿瘤切除术前或术后曾行放射治疗,其中动脉破裂前手术创面经胸三角皮瓣修复1例,额部带蒂皮瓣修复1例,游离前臂皮瓣修复1例.动脉破裂止血成功后5例局部清创,根据情况的需要,必要时采用肌瓣修复.结果 7例患者中5例患者经X线导管介入得到成功救治,其中3例采用动脉内置覆膜支架,2例行动脉栓塞;另2例因瞬间出血量大而来不及救治死亡.救治成功病例其动脉危险区随后经胸大肌皮瓣修复2例,颏下瓣修复1例,局部肌瓣修复1例,另1例因创面较小而未行皮瓣修复.颈总动脉破裂经置人覆膜支架成功救治的3例患者目前已分别生存6、12及20个月;2例颈总动脉破裂介入栓塞患者分别于抢救成功后2个月和13个月死于血管再破裂.结论 有预案的及时抢救,采用X线介入治疗是抢救颈部大动脉破裂的有效方法,救治后应及时采用转移肌皮瓣覆盖保护动脉.X线介入覆膜支架可基本恢复头颈部正常的血供,并发症少,可能较动脉栓塞更为可靠.     

Usefulness of supraclavicular flap in reconstruction following resection of oral cancer

ObjectiveTo evaluate the usefulness of supraclavicular artery flap in reconstruction of defects following resection of buccal mucosa cancer.MethodsTwenty-five patients who presented to R.L Jalappa Hospital and Research centre and diagnosed as squamous cell carcinoma of buccal mucosa staged T₂ and above were included in our study. All patients underwent wide excision of tumour and neck dissection. Six patients underwent hemi-mandibulectomy while 4 patients underwent marginal mandibulectomy depending on extent of the tumour along with neck dissection. The defect following surgery was reconstructed using the supraclavicular artery flap and were followed up for minimum 6 months during which they were assessed for the functional and aesthetic outcome using a scoring system. The details of the scoring system comprised of 7 attributes. Each attribute was given a score of 10 if the patients experienced that attribute, while a score of 0 was given if the patient did not experience that particular attribute.ResultsSeven (28%) patients had complete necrosis of the flap. One patient had a local recurrence 2 months following surgery and was lost to follow up. The remaining 17 patients were followed up for a minimum of 6 months and a scoring system was adopted to evaluate the functional and aesthetic outcome of the supraclavicular flap. We observed that 14 patients had an excellent outcome score (58%), 3 patients had a good outcome score (13%), while 7 patients (28%) had flap necrosis.ConclusionsWe find the supraclavicular flap to be safe, technically simple, sensate, thin, pliable and reliable regional fasciocutaneous flap in reconstructing intra oral defects. Preserving the external jugular vein and sacrificing supraclavicular nerves give good outcome.     

Surgical treatment of pharyngostomes in irradiated patients. Our experience with musculocutaneous pectoralis major flap and hyperbaric oxygen therapy

Conclusion. Our experience confirms that pectoralis major flap is the first-choice technique for repairing recurrent hypopharyngeal fistulae in previously irradiated patients in whom microsurgical techniques are not indicated, and that hyperbaric oxygen therapy helps to solve this complex pathology.Objectives. A pharyngostome is a complication encountered when performing surgical operations on pharyngolaryngeal structures. The authors present their experience of treating recurrent complex pharyngostomes in previously irradiated patients in poor physical health. These patients need a simple, safe reconstruction with a low incidence of postoperative complications.Material and methods. A pedicled pectoralis major flap was used for reconstruction: the skin side of the flap was used to restore the continuity of the pharyngeal mucosa, while the muscle was used to reconstruct the intermediate layer. The skin layer was completed by means of a free skin graft. In all cases, surgical treatment was combined with hyperbaric oxygen therapy before and after the operation.Results. A total of 10 patients, all of whom had previously undergone surgery and radiotherapy, had recurring or pluri-recurring pharyngostomes. All patients (8 males, 2 females; age range 52–80 years) had previously been affected by carcinoma of the pharyngolaryngeal region. All underwent major local Ablation together with radical neck dissection and radiotherapy. In all cases there was mucosa on the posterior wall; a musculocutaneous pectoralis major flap was used in all cases for reconstruction.     

The latissimus dorsi flap in head and neck reconstructive surgery: a review of 121 procedures

The results of a prospective study of 121 latissimus dorsi flaps performed during head and neck reconstructive surgery at the Royal Marsden Hospital are presented. Three-quarters of the flaps were pedicled and one-quarter were free. All the patients underwent surgery for malignant disease. The flap failure rate was 5%, other flap related complications occurred in 19% and the overall rate of complications was 26%. Previous radiotherapy, site of reconstruction, type of flap (free or pedicled) and age of the patient were not significant risk factors. Men were more likely to have a complication than women.     

Clinical application of supraclavicular flap for head and neck reconstruction

European Archives of Oto-Rhino-Laryngology - To assess the efficacy and clinical application of a supraclavicular flap for head and neck reconstruction. A pedicled supraclavicular flap was used on...