胸大肌瓣加原位皮片移植修复鼻咽癌放疗后颈部复发的术后缺损

摘要

目的：胸大肌皮瓣是头颈部术后缺损常用的修复皮瓣，但由于它的臃肿常导致术后较高的并发症发生。本文将介绍我院采用胸大肌皮瓣去脂、原位皮片植皮在鼻咽癌放疗后颈部复发术后皮肤缺损修复中的应用。方法：对2007年1月-2012年1月就诊中山大学肿瘤防治中心的8例鼻咽癌根治性放疗后颈部复发侵犯颈部皮肤及皮下组织患者，采用胸大肌皮瓣去脂、原位皮片植皮修复颈部大面积皮肤及皮下组织缺损。常规取胸大肌皮瓣，切除皮瓣的皮肤及皮下脂肪，从切除的皮肤中获取表皮和真皮层植皮在胸大肌上，打包7天。结果：皮瓣大小6cm ×9cm -6cm ×15cm，常规测量切除的皮下脂肪厚度，平均15.13mm（n ＝8）。所有皮瓣及移植皮片均存活良好，所有患者对术后供区、受区外观满意。结论：本方法简便易行，创伤小，成活率高，改善胸大肌皮瓣臃肿的同时修复了颈部皮肤缺损，不仅能恢复功能，还有较好的外形。%Objective:The Pectoralis major myocutaneous flaP(PMMF)is a commonly used flaP in reconstructive head and neck surgery,but in literature,the flaP is also associated with a high incidence of comPlications due to its large bulk. The aim of the current study was to introduce PMMF Plus in situ skin graft for reconstruction of neck de-fects in irradiated nasoPharynx carcinoma Patients. Methods:From January 2007 to January 2012,8 debulking Proce-dures were Performed on 8 Patients who had received reconstruction with PMMF for defect of the neck. All Patients have recurrent nasoPharynx carcinoma after radical radiotheraPy with clinically PalPable cervical lymPh node metasta-ses and metastatic dePosits involving the neck skin and the underlying soft tissues. The ePidermis and most of the der-mis were harvested from the flaP,regrafted on the defatted flaP and fixed with tie - over dressing for 7 days. Results:The areas of flaP size ranged from 6cm × 9cm to 6cm × 15cm. The average thickness of removed fat was 15. 13mm(n= 8). All the grafted skin and PMMF took well. All Patients were satisfied with aesthetic result of the donor site and the receiving site after surgery. Conclusion:This method can Provide strict thin skin coverage for the neck after PMMF reconstruction to achieve good functional and esthetic requirements.