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目的 :探讨改良胸大肌肌皮瓣在复发性头颈癌挽救性手术缺损重建中的应用价值。方法 :选择19例局部复发头颈癌患者,复发癌临床分期为2例r CSⅢ期,17例r CSⅣ期;挽救性手术前,17例接受肿瘤根治手术,16例接受放射治疗。应用胸大肌肌皮瓣重建挽救性手术缺损,制备时血管蒂内同时保留胸肩峰血管的胸肌支及胸外侧血管的分支,形成起始部不含肌肉的双蒂血管筋膜束。结果:胸大肌肌皮瓣全部成活,2例肌皮瓣与受区缝合处局部开裂,经换药1例5周后延期愈合,1例不愈出现咽瘘;13例患者的血管蒂置于锁骨下,另6例血管蒂位于锁骨表面;蒂长平均15.7 cm,最长达20 cm,修复高度达颧弓平面。随访6~48个月,10例患者无复发生存,5例患者带瘤生存,4例患者死于肿瘤复发和转移。结论:改良后的胸大肌皮瓣,双血管供血血运得到充分保证,避免了皮瓣局部坏死,其修复半径明显延长,解决了保留胸外侧血管修复半径缩短的难题,在复发头颈癌挽救性手术缺损重建中应用效果满意。
Objective: To explore the value of modified pectoralis major myocutaneous flap in the reconstruction of salvage surgery for recurrent head and neck cancer. Methods: Nineteen patients with locally recurrent head and neck cancer were selected. The clinical stage of recurrence was 2 cases of r CS stage and 17 cases of r CS Ⅳ stage. Before salvage surgery, 17 cases underwent radical operation and 16 cases received radiotherapy. The pectoralis major myocutaneous flap was used to reconstruct the salvage surgery defect. During the preparation, the branches of the thoracolumbar and thoracic vessels in the pedicle of the thoracolumbar vertebra were preserved, and the muscle-free dual-pedicle vascular fascia bundle was formed at the beginning. Results: All the pectoralis major myocutaneous flaps survived, and 2 cases of myocutaneous flap were partially dehiscted at the suture area. One case of dressing changed postoperatively for 5 weeks and delayed hemangiogenesis in one case. Vascular pedicle of 13 cases In the subclavian bone, the other 6 cases were located on the surface of the clavicle. The average length of pedicle was 15.7 cm and the longest was 20 cm. The height of the pedicle was restored to the zygomatic arch plane. All patients were followed up for 6 ~ 48 months. No recurrence was found in 10 patients, 5 patients survived with tumor, and 4 patients died of tumor recurrence and metastasis. Conclusion: The modified pectoralis major muscle flap and double blood vessel blood supply are fully guaranteed, to avoid local necrosis of the flap, the repair radius was significantly extended to solve the retention of the thoracic vascular repair radius shortening problems in the recurrence of head and neck cancer rescue Satisfactory results have been achieved in reconstructive surgery.