CAJ | 학술논문

目的：探讨带蒂岛状胸大肌肌皮瓣对头颈部恶性肿瘤切除术后大面积软组织缺损一期修复重建中的疗效。方法2011年4月至2012年9月该院对27例头颈部恶性肿瘤术后大面积软组织缺损采用带蒂岛状胸大肌肌皮瓣一期修复重建，其中舌癌11例、腮腺癌2例、牙龈癌3例、口咽癌2例、口底癌9例。结果27例患者安全度过围术期，27例岛状胸大肌肌皮瓣均成活，患者在外观和功能上均获得满意的临床疗效。术后发生颈部血肿1例，及时探查清除血肿，彻底止血后消除；1例因皮瓣表皮坏死清除坏死皮肤，肌瓣成活，表面肉芽修复，不影响治疗效果。结论岛状胸大肌肌皮瓣在头颈部恶性肿瘤术后大面积软组织缺损重建、修复有其独特优越性，其组织量丰富，胸肩峰动脉解剖位置恒定，手术易操作，血供丰富，抗感染能力强，成活率高。术中操作精细是岛状胸大肌肌皮瓣成活的关键。
목적：탐토대체도상흉대기기피판대두경부악성종류절제술후대면적연조직결손일기수복중건중적료효。방법2011년4월지2012년9월해원대27례두경부악성종류술후대면적연조직결손채용대체도상흉대기기피판일기수복중건，기중설암11례、시선암2례、아간암3례、구인암2례、구저암9례。결과27례환자안전도과위술기，27례도상흉대기기피판균성활，환자재외관화공능상균획득만의적림상료효。술후발생경부혈종1례，급시탐사청제혈종，철저지혈후소제；1례인피판표피배사청제배사피부，기판성활，표면육아수복，불영향치료효과。결론도상흉대기기피판재두경부악성종류술후대면적연조직결손중건、수복유기독특우월성，기조직량봉부，흉견봉동맥해부위치항정，수술역조작，혈공봉부，항감염능력강，성활솔고。술중조작정세시도상흉대기기피판성활적관건。
Objective To investigate the primary repair methods and efficacy of island pedicled pectoralis major muscle flap in soft tissue defect after the operation of head and neck malignant tumors .Methods From April 2011 to September 2012 ,27 patients from this hospital who underwent primary repair using island pedicled pectoralis major muscle flap after a head and neck extensive soft tissue defect were investigated ,including 11 cases of tongue cancer defect ,2 cases of parotid gland defect ,3 cases of gum cancer defect ,2 cases of oropharyngeal cancer defect ,9 cases of floor of the mouth cancer defect .Results 27 patients were safety in periop-erative ,27 cases of island pectoralis major muscle flap survived ,patients were satisfied with both the appearance and function .There was postoperative neck hematoma in 1 patient ,it was eliminated through timely remove the hematoma and hemostasis completely ;There was 1 case of removing the epidermal necrolysis skin as flap necrosis ,while it was acceptable efficacy as the muscle flap sur-vival and surface granulation repaired .Conclusion Island pectoralis major muscle flap obtains unique advantages in repairing a large area of soft tissue defect in head and neck cancer patients after operation ,such as abundant of tissue ,a constant arterial anatomy of thoracoacromial ,easy to operate ,rich blood supply ,strong resistance to infection ,high survival rate and so on .A fine surgery opera-tion is the key of island pectoralis major muscle flap survival .