改良胸大肌肌皮瓣在晚期头颈肿瘤手术中的应用

目的探讨一种保留胸大肌功能的改良胸大肌肌皮瓣的制作方法。方法根据胸大肌肌皮瓣的解剖学特点设计皮岛，将胸大肌肌皮瓣的血管蒂完全解剖出来而不携带肌肉，使肌皮瓣成为名副其实的岛状瓣，从而完整保留了胸大肌的锁骨部分以及胸大肌外侧大部分肌纤维。结果2002至2005年采用该方法制做改良胸大肌肌皮瓣29例，其中20例修复口内缺损，4例修复颈部缺损。3例修复腮腺区缺损，2例修复下咽部缺损。术后皮瓣全部成活，随访6个月至2年，所有患者术后进食、吞咽功能良好，语言功能大多恢复良好。结论改良胸大肌肌皮瓣应用于头颈外科克服了传统的胸大肌肌皮瓣的缺点，提高了肌皮瓣血供的可靠性，最大程度地保留了胸大肌的功能和胸部的外形。     

胸大肌肌皮瓣移位修复面颌颈胸部难治性创面

面颌颈及胸部各种原因所致的深度创面，一期修复均较为困难。１９８９年１１月～１９９６年４月，采用胸大肌肌皮瓣或胸大肌岛状肌瓣移位修复１１例，其中肌皮瓣８例，肌瓣３例，面积１２ｃｍ×８ｃｍ～２６ｃｍ×１８ｃｍ。术后创面Ⅰ期愈合１０例，１例创面轻度感染，换药治愈。详细介绍了手术方法和手术要点，讨论了胸大肌肌皮瓣移位对此类创面修复的优越性。     

胸大肌肌皮瓣在口腔颌面部缺损修复中的应用

报道２１９例口腔颌面部肿瘤，其中良性肿瘤１８例，恶性肿瘤２０１例，在肿瘤切除后，均采用胸大肌肌皮瓣修复缺损。采用单皮岛肌皮瓣２０１例，双皮岛肌皮瓣１６例，肌皮骨瓣２例。成功２０１例，失败１８例。讨论了胸大肌皮瓣的优点及适用范围。介绍了手术设计、操作方法。分析了成功与失败的影响因素，认为正确，精细的手术技巧是成功的关键因素。     

腰椎后路术后切口脂肪液化相关危险因素分析

目的 探讨腰椎后路术后切口脂肪液化相关危险因素.方法 分析387例行腰椎后路手术患者的资料,根据术后切口是否发生脂肪液化分为正常组(355例)和脂肪液化组(32例).采用logistic回归分析筛选影响术后切口脂肪液化的相关危险因素.结果 性别、年龄、术后引流管留置时间两组比较差异均无统计学意义(P>0.05),体重指...     

胸大肌肌皮瓣修复口腔颌面部恶性肿瘤切除术后缺损

目的探讨采用胸大肌肌皮瓣即刻修复口腔颌面部恶性肿瘤切除术后组织缺损的方法、临床经验以及并发症的发生及预防。方法2002年1月～2005年12月,对18例口腔颌面部恶性肿瘤术后缺损应用胸大肌肌皮瓣进行即刻修复的效果。其中男13例,女5例;年龄31～77岁。原发疾病组织病理类型均为鳞状细胞癌,其中舌癌12例,口底癌3例,下颌牙龈癌2例,颊癌1例。TNM分类：T2N0M05例,T2N1M08例,T2N2aM02例,T3N1M01例,T3N2bM01例,T4N2bM01例。术前化疗3例,放疗6例,化疗加放疗2例,未作治疗7例。18例均行根治性颈淋巴清扫术,其中有2例行对侧功能性颈淋巴清扫术。有17例行预防性气管切开术。缺损范围3cm×3cm～8cm×5cm,制备的胸大肌肌皮瓣范围为5cm×4cm～10cm×6cm。结果术后16例胸大肌肌皮瓣完全成活,皮瓣无坏死或其他并发症发生;2例皮瓣边缘小部分坏死,出现皮肤口腔瘘,行二期修复治愈。18例获随访1～3年,缺损处外形及吞咽、发音功能恢复良好,肿瘤无复发。结论胸大肌肌皮瓣成活率高,安全可靠,在口腔颌面部恶性肿瘤手术修复中有较广泛的适应证,并可修复较大面积的缺损。     

胸大肌肌皮瓣修复口腔颌面部肿瘤切除后的缺损

口腔颌面部恶性肿瘤根治手术或肿瘤术后放射性骨髓炎导致的缺损，尤其是大面积缺损，造成患者颜面部畸形以及语言、咀嚼、吞咽等功能障碍，严重影响患者的生存质量。随着显微外科技术的提高，各种带蒂和游离组织瓣被用来移位修复缺损。在众多组织瓣中，胸大肌肌皮瓣具有其独特的优越性，被广泛应用于口腔颌面部缺损的重建。我们于1999年8月～2004年11月，应用带蒂或游离胸大肌肌皮瓣修复口腔颌面部组织缺损9例，取得良好临床效果。报告如下。     

胸大肌肌皮瓣与中厚皮片修复颈部咽瘘

目的探索以胸大肌肌皮瓣及中厚皮片联合修复颈部咽瘘的方法。方法对因头颈部恶性肿瘤术后与放疗后形成颈部的咽瘘,应用胸大肌肌皮瓣与中厚皮片联合修复咽食管黏膜及颈部皮肤缺损。结果本组11例皮瓣术后全部存活,术后5d去除中厚皮片之缝线包扎敷料,术后12~14d拆线,其中2例皮瓣边缘部分愈合不良,经换药后愈合。术后随访全部皮瓣及中厚皮片存活良好,患者吞咽功能恢复,外形良好。结论胸大肌肌皮瓣与中厚皮片联合用于颈部咽瘘的修复可获得良好的临床效果。     

胸大肌皮瓣改良切取术临床比较

目的：通过改良的胸大肌肌皮瓣及蒂部经锁骨上或下隧道成功率之间的比较，验证两者与皮瓣成活率之间的关系，为推广蒂部经锁骨下隧道寻找依据。方法：对肌蒂经锁骨上或下隧道穿行共１００例进行临床对比研究，并提出改良的方法。结果：肌蒂经锁骨上或下隧道成活率分别为９４．７４％、９５．４０％；两组并发症经ｔ检验，Ｐ＞０．０５，两者差异无显著性。结论：经改良的胸大肌肌皮瓣切取法经锁骨下隧道通过是安全可行的，并有其优点，建议推广应用     

Pharyngo-esophageal reconstruction by pectoralis major myocutaneous flaps

Summary The authors want to show that the island pectoralis major myocutaneous flap has proved to be now the most effective for immediate pharyngoesophageal and neck reconstruction as stated in three preliminary publications which were the first positive reports about this technique.     

Selective transposition of the pectoralis major myocutaneous flap: an electromyographic evaluation

Although it has been postulated that the segmental anatomy of the pectoralis major muscle should allow intact motor function to be preserved at the donor site after a myocutaneous island flap has been transposed, the functional outcome of this selective harvesting technique has not been previously investigated. In this study the degree of innervation of the residual pectoralis major muscle on the chest after traditional (10 patients) and selective (10 patients) pectoralis major myocutaneous flap transposition has been evaluated using postoperative electromyography. According to the data obtained, while an intact innervation of the external segment is maintained utilizing both techniques, it is impossible to preserve functional innervation of the remaining sternocostal strip medial to the donor site during a pectoralis major myocutaneous flap transposition, even after its selective harvesting.     

Microvascular salvage of a failing pectoralis major myocutaneous flap

Summary While being elevated prior to reconstruction of a left-sided neck defect, a pectoralis major myocutaneous island flap was rendered ischemic by the inadvertant transection of the pectoral branch of the thoracoacromial artery. In order to save the flap, a microvascular repair between the distal end of this vessel and the ascending branch of the transverse cervical artery was performed. The flap was successfully revascularized and the patient went on to uneventful healing with 100% flap viability. This technique could be used following similar technical error in the elevation of any axial pattern flap providing that suitable vessels for repair were present.     

Closure of infected sternal wounds with a unilateral rectus abdominis muscle flap in addition to bilateral pectoralis major myocutaneous advancement flaps

We have recently added to our regimen a unilateral rectus abdominis muscle flap to cover the lower sternum and adjacent soft tissues, in addition to bilateral pectoralis major myocutaneous advancement flaps for closure of infected sternal wounds. Twenty patients underwent this procedure for closure of infected sternal wounds after initial débridement at our institutions. There were no intraoperative deaths in this series, but three patients died of other medical conditions. Two patients developed hematomas and one developed recurrent sternal wound infection after surgery; two had superficial wound infections and five had minor wound problems (i.e., skin edge necrosis). All surviving patients (17/20, 85%) had healed sternal wounds with normal chest contour and there were no instances of flap necrosis, sternal wound dehiscence, or abdominal wall hernia during the follow-up (18–60 months). Based upon our experience, we recommend a unilateral rectus abdominis muscle flap in addition to bilateral pectoralis major myocutaneous advancement flaps for selected patients with infected sternal wounds. This approach provides reliable soft tissue coverage with acceptable morbidity and mortality in this high-risk patient population. Received: 29 July 1998 / Accepted: 1 March 1999     

A cross-over pectoralis myocutaneous flap

Summary A right pectoralis major myocutaneous flap was raised and crossed over the midline to cover an exposed clavicle. This again illustrates the versatility of the pectoralis myocutaneous flap.     

应用胸大肌岛状肌皮瓣重建全舌体、口底的初步报告

目的 探讨累及双侧的舌癌根治术后全舌体、口底重建的有效方法及临床评价。方法 对2000年10月至2002年12月问我科收治的7例累及双侧的舌癌患者实施根治性手术，造成全舌体、口底的大面积缺损，采用一侧胸大肌岛状肌皮瓣转移即时重建全舌体和双侧口底。结果 6例转移肌皮瓣完全成活，口腔和颈、胸部创面均一期愈合。1例肌皮瓣远端部分皮肤坏死，但无口底颌下瘘和感染等并发症发生。术后随访2～16个月，重建舌体、口底形态基本满意，语言功能大部分恢复，吞咽功能恢复良好。1例在术后9个月死于肿瘤肺转移，其余6例目前均继在。结论 胸大肌岛状肌皮瓣组织量大，血供丰富，是全舌体、口底重建的理想选择。     

The pectoralis major myocutaneous flap in head and neck reconstruction

Summary This paper discusses the pectoralis major myocutaneous flap, its anatomy, preparation, and dissection, for use in head and neck reconstruction. Illustrative cases are reviewed and the advantages of this flap presented.     

游离股前外侧皮瓣与改良胸大肌皮瓣在修复头颈肿瘤术后缺损中的选择与改进

目的探讨游离股前外侧皮瓣与改良胸大肌皮瓣在头颈肿瘤术后缺损修复中的应用及效果。方法2011年11月至2016年11月湖南省肿瘤医院头颈外科收治头颈部肿瘤患者394例,男性286例,女性108例,年龄25~79岁。分别采用游离股前外侧皮瓣(306例)、改良胸大肌皮瓣(88例)修复头颈肿瘤术后缺损。采用t检验法分析不同方法修复的效果及患者生存质量,总结2种皮瓣修复的优缺点及适应证。结果本组394例,游离股前外侧皮瓣组皮瓣成活率97.1%(297/306),改良胸大肌皮瓣组成活率97.7%(86/88);手术总时间2组相近,游离股前外侧皮瓣组3~4 h,改良胸大肌皮瓣组1.5~2.5 h;术后1年,UW-QOL评分游离股前外侧皮瓣组与胸大肌皮瓣组相比,在外观、言语功能及肩部运动方面有显著优势,差异有统计学意义(P<0.05)。结论头颈部肿瘤术后缺损修复中,游离股前外侧皮瓣及改良胸大肌皮瓣都具有较高的成功率,游离股前外侧皮瓣适用于复杂缺损的修复,改良胸大肌皮瓣对血管条件、全身状况不佳的患者,更具有安全性。     

Simple pectoralis major myocutaneous advancement flaps for closure after sternal wound dehiscence

Between October 1994 and March 1996, 14 consecutive patients with a wound dehiscence after median sternotomy for cardiac surgery were treated with pectoralis major myocutaneous advancement flaps. After thorough sternal wound debridement, the sternal edges were contoured to create a shallow defect. This was to enable the obliteration of dead space between the mediastinum and the flaps. The pectoralis muscle was then elevated off the chest wall, its humeral attachment, the thoraco-acromial pedicle and the connection with the skin were left intact. Next, the bilateral myocutaneous flaps were advanced medially and approximated to each other in the midline. The mean operation time was 140 min and the mean follow-up time was 10 months. Four patients developed minor complications. The advantage of this technique is its simplicity and the reduction in mean operation time. Received: 30 December 1999 / Accepted: 3 February 2000