游离组织瓣联合胸大肌皮瓣移植修复大型头颈部缺损

华西口腔医学杂志

游离组织瓣联合胸大肌皮瓣移植修复大型头颈部缺损

毛驰;俞光岩;彭歆;张雷;郭传瑸;黄敏娴

北京大学口腔医院口腔颌面外科，北京 100081

收稿日期:2006-02-25 修回日期:2006-02-25 出版日期:2006-02-20 发布日期:2006-02-20
通讯作者: 毛驰, Tel: 13910003306
作者简介:毛驰（1966-）, 男, 浙江人, 教授, 博士

Combined Free Flap and Pedicled Pectoralis Major Myocutaneous Flap in Reconstruction of Extensive Composite Defects in Head and Neck Region: A Review of 9 Consecutive Cases

MAO Chi, YU Guang-yan, PENG Xin, ZHANG Lei, GUO Chuan-bin, HUANG Min-xian

Dept. of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Beijing 100081, China

Received:2006-02-25 Revised:2006-02-25 Online:2006-02-20 Published:2006-02-20

摘要/Abstract

摘要：

目的探讨联合应用游离组织瓣和带蒂胸大肌皮瓣移植修复大型头颈部缺损的可靠性和应用价值。方法对9例联合应用游离组织瓣和带蒂胸大肌皮瓣行头颈部缺损修复的患者作回顾性研究，分析头颈部缺损的类型、受区血管情况、游离组织瓣的类型、组织瓣成活情况及术后并发症，探讨有可能影响组织瓣成活的因素。结果 9例患者采用的游离瓣包括前臂瓣6例、腓骨瓣2例和大腿前外侧皮瓣1例。1例前臂皮瓣于术后24 h出现静脉危象，经紧急手术探查和重新吻合血管后获得成活，其余游离瓣术后均未出现血管危象，全部成活。9例患者的9块胸大肌皮瓣也均获得成活。结论游离组织瓣联合带蒂胸大肌皮瓣移植主要适用于无法或不适合作双游离瓣移植的大型头颈部缺损修复，安全性较高，在大型头颈部复合缺损的修复中有一定的应用价值。

关键词: 胸大肌皮瓣, 游离组织瓣, 重建外科手术

Abstract:

Objective To analyze the value and reliability of combined free flap and pedicled pectoralis major myocutaneous flap in the reconstruction of extensive composite head and neck defects. Methods Nine consecutive cases of combined free flap and pedicled pectoralis major myocutaneous flap transfers for extensive head and neck defects from March 2002 to April 2005 were reviewed. Data concerning the operation included defect description, type of free flap, recipient vessel and complications. Results There were 9 cases in this group, with 7 males and 2 females. Among the 9 free flaps, there were 6 radial forearm flaps, two fibula flaps, and one anterolateral thigh flap. The overall flap survival rate was 100%(all of 18 flaps), without partial or total flap necrosis. One radial forearm flap developed venous thrombosis 24 hours after operation, but salvaged by emergent exploration and re-anastomosis of veins. The overall complication rate was 44.4%. Conclusion In selected cases, the combined free flap and pedicled pectoralis major myocutaneous flap method provided satisfactory reconstruction for extensive head and neck defect, and simplified the double free flap method.

Key words: freeflap, pectoralismajormyocutaneousflap, reconstructivesurgicalprocedures

毛驰;俞光岩;彭歆;张雷;郭传瑸;黄敏娴. 游离组织瓣联合胸大肌皮瓣移植修复大型头颈部缺损[J]. 华西口腔医学杂志.

MAO Chi, YU Guang-yan, PENG Xin, ZHANG Lei, GUO Chuan-bin, HUANG Min-xian. Combined Free Flap and Pedicled Pectoralis Major Myocutaneous Flap in Reconstruction of Extensive Composite Defects in Head and Neck Region: A Review of 9 Consecutive Cases[J]. West China Journal of Stomatology.

[1]	毛驰;俞光岩;彭歆;张雷;郭传瑸;黄敏娴. 吻合两条静脉的头颈部游离组织瓣移植[J]. 华西口腔医学杂志, 2006, 24(06): 530-532.
[2]	姚金光;李龙江;李俊;陈海波;罗修汉. 带蒂颊脂垫衬里与颞肌筋膜瓣联合钛网重建上颌骨缺损[J]. 华西口腔医学杂志, 2006, 24(01): 57-59.
[3]	毛驰,俞光岩,彭歆,郭传瑸,黄敏娴,张益. 儿童患者头颈部游离组织瓣移植的临床分析[J]. 华西口腔医学杂志, 2004, 22(06): 477-480.
[4]	毛驰,俞光岩,彭歆,孙勇刚,张益,郭传. 游离组织瓣移植同期修复下颌骨放射性骨坏死术后缺损[J]. 华西口腔医学杂志, 2004, 22(04): 305-308.
[5]	毛驰,俞光岩,彭歆,郭传瑸,黄敏娴,张益. 144例头颈部游离组织瓣移植患者的临床分析[J]. 华西口腔医学杂志, 2002, 20(06): 423-425.