中国修复重建外科杂志

中国修复重建外科杂志

带蒂胸肩峰动脉嵌合穿支肌皮瓣修复下咽环周缺损

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目的 探讨带蒂胸肩峰动脉嵌合穿支肌皮瓣修复下咽环周缺损的临床效果。 方法 2013 年 1 月—2014 年 12 月,采用带蒂胸肩峰动脉嵌合穿支肌皮瓣修复 8 例复杂性下咽环周缺损患者。男 6 例,女 2 例;年龄 45~80 岁,平均 57 岁。均为外院治疗后下咽癌复发者,结束治疗至复发确诊时间为 3~28 个月,平均 16.5 个月。按国际抗癌联盟(UICC)TNM 分类分期:T2N1M0 3 例,T3N1M0 2 例,T3N2M0 1 例,T4N1M0 2 例。全喉全下咽切除术后,下咽环周缺损范围为 9.0 cm×8.5 cm~12.0 cm×10.5 cm;带蒂胸肩峰动脉嵌合穿支肌皮瓣的穿支皮瓣皮岛范围为 7.0 cm×4.0 cm~9.5 cm×6.0 cm,胸大肌肌皮瓣皮岛范围为 9.0 cm×5.0 cm~14.5 cm×6.0 cm。供区均直接拉拢缝合。 结果 术后皮瓣顺利成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合,无早期相关并发症发生。患者住院时间 12~22 d,平均 14.5 d。术后 8 周所有患者均恢复正常饮食。患者均获随访,随访时间 12~45 个月,平均 18.7 个月。所有患者颈部外形良好,未见肿瘤复发,未发生咽瘘、切口裂开和肿胀等情况,皮瓣不臃肿,重建的下咽腔无狭窄。供区仅遗留线性瘢痕,胸大肌功能未见明显影响。 结论 复杂的下咽环周缺损往往存在颈部受区血管缺如情况,不适合采用游离组织瓣移植修复,带蒂胸肩峰动脉嵌合穿支肌皮瓣可以作为一种局部重建替代治疗方案。

Objective To explore the effectiveness of pedicled chimeric thoracoacromial artery perforator (TAAP) flap as a reconstructive option for circular hypopharyngeal defects. Methods Between January 2013 and December 2014, the pedicled chimeric TAAP flap was used to repair oncologic circular hypopharyngeal defects in 8 patients, included 6 males and 2 females, with an average age of 57 years (range, 45-80 years). All patients were treated in other hospitals before and recurrence was noted. The duration between latest treatment and recurrence ranged from 3 to 28 months (mean, 16.5 months). According to Union for International Cancer Control (UICC) TNM staged, 3 cases were T2N1M0, 2 cases were T3N1M0, 1 case was T3N2M0, 2 cases were T4N1M0. After laryngectomy, the size of circular hypopharyngeal defect ranged from 9.0 cm×8.5 cm to 12.0 cm×10.5 cm. The size of TAAP flap ranged from 7.0 cm×4.0 cm to 9.5 cm×6.0 cm.The size of pectoralis major flap ranged from 9.0 cm×5.0 cm to 14.5 cm×6.0 cm.The donor sites were closed directly in all cases. Results Postoperatively all flaps survived smoothly, and all defects healed by first intention. No early complication was noted. The mean hospital stay period ranged from 12 to 22 days (mean, 14.5 days). All patients were followed up 12-45 months (mean, 18.7 months). Patients possessed good appearance of surgical sites. No recurrence, fistulas, stenosis/strictures, dehiscence, or swelling occurred. Only linear scars were left on the donor sites, and the pectoralis major muscle function was completely preserved in all patients. Conclusion Patients with high comorbidities may not be suitable candidates for free flap reconstruction, especially when the recipient vessels are affected from disease or radiotherapy. Pedicled chimeric TAAP flap is a good choice for the reconstruction of hypopharyngeal defects in such conditions.

关键词: 下咽重建; 环周缺损; 胸肩峰动脉; 穿支皮瓣; 嵌合皮瓣; 胸大肌皮瓣

Key words: Hypopharyngeal reconstruction; circular defect; thoracoacromial artery; perforator flap; chimeric flap; pectoralis major flap

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