组织量丰富的胸大肌肌皮瓣在头颈部缺损修复中的应用研究

发布时间：2018-01-30 08:46

本文关键词： 头颈部缺损修复胸大肌肌皮瓣重建　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨组织量丰富的胸大肌肌皮瓣在头颈部肿瘤切除术后缺损修复的手术技巧及术后并发症的处理与预防。方法筛选2008年1月1日~2014年10月1日期间,于我院耳鼻咽喉头颈外科行头颈恶性肿瘤切除术后使用胸大肌肌皮瓣修复缺损的部分患者(仅包括超重/肥胖男性患者及女性患者),回顾性总结相关手术技巧及相应的术后并发症的处理经验。对于超重/肥胖男性或/和女性患者,其胸大肌肌皮瓣组织量丰富,利用改良的方法设计制备后,可修复头颈部各种缺损。皮岛通常设计在乳晕内下侧的胸大肌表面。皮岛皮肤、皮下组织的切面与胸大肌筋膜表面所形成夹角应不小于45°;于皮岛外侧1cm左右切断胸大肌内侧、下侧及外侧至肋骨骨膜和肋间肌表面,再于其表面向上剥离胸大肌至胸小肌表面;通过透视方法找出胸大肌肌皮瓣的血管蒂;制备好胸大肌肌皮瓣将其拉到缺损处,首先将胸大肌肌皮瓣的肌肉部分固定于术后缺损处,再将皮肤与受区的肌肉或粘膜对缝;修复后胸大肌肌皮瓣周围潜在的腔隙均需要放置负压引流。结果本研究共23例,其中1例超重/肥胖患者在制备胸大肌肌皮瓣过程中误伤胸肩峰动脉,术中改为制备另一侧胸大肌肌皮瓣。制备完好的共23例胸大肌肌皮瓣全部成活,其中只有1例远端部分坏死,经换药后二期愈合;共有3例受区感染,形成咽漏,换药治疗后Ⅱ期愈合;1例患者受区皮肤与皮瓣部分裂开,同样经换药处理,Ⅱ期愈合;另有1例患者供区出现皮下积血,及时清理淤血后愈合。结论组织量丰富的胸大肌肌皮瓣,不论是超重/肥胖的男性患者还是女性患者,由于血管走向恒定、血供丰富,虽然臃肿,制备和修复时比较困难,但只要确保手术中正确定位,细心识别血管蒂,仔细操作,术后积极密切监测和护理皮瓣及时发现并发症,并给予有效处理,肌皮瓣与创面仍可良好愈合,因此该类皮瓣仍然是头颈部术后缺损修复重建的重要皮瓣。
[Abstract]:Objective to explore the surgical techniques and prevention of postoperative complications of pectoralis major myocutaneous flap with abundant tissue in repairing defects after head and neck tumor resection. Methods from January 1st 2008 to October 2014, we selected. During 1st. Partial patients (including overweight / obese male and female) who were treated with pectoralis major myocutaneous flap after resection of malignant tumor of head and neck in our hospital. A retrospective review of the relevant surgical techniques and the corresponding experience in the management of postoperative complications. For overweight / obese male or / and female patients, the pectoralis major myocutaneous flap is abundant, using the improved method of design and preparation. All kinds of defects in head and neck can be repaired. The skin island is usually designed on the surface of pectoralis major muscle on the lower side of the medial areola. The angle between the cut surface of the subcutaneous tissue and the surface of the pectoralis major fascia should not be less than 45 掳in the skin of the skin island. The medial part of pectoralis major muscle was cut off about 1 cm outside of the skin island, and the lower and lateral sides were cut to the surface of the rib periosteum and intercostal muscle, and then the pectoralis major muscle was removed from the surface to the surface of the pectoralis minor muscle. The vascular pedicle of pectoralis major myocutaneous flap was found by fluoroscopy. The pectoralis major myocutaneous flap was prepared to pull it to the defect. First, the muscle part of the pectoralis major myocutaneous flap was fixed to the defect after operation, and then the skin was sutured with the muscle or mucous membrane of the recipient area. Negative pressure drainage was needed in all the potential spaces around the pectoralis major myocutaneous flap. Results in this study, 23 patients were involved in this study, including 1 overweight / obese patient who accidentally injured the pectoralis acromiosus artery during the preparation of the pectoralis major myocutaneous flap. The other pectoralis major myocutaneous flap was prepared during the operation. All of the 23 intact pectoralis major myocutaneous flaps survived, in which only 1 case had partial distal necrosis and healed after dressing change. A total of 3 cases were infected in the recipient area, pharyngeal leakage was formed, and the second stage healed after dressing change. In one case, the skin of the recipient area was partially split from the skin flap, which was also treated by dressing change, and healed in the second stage. Another patient had subcutaneous hemorrhage in the donor area and healed after clearing the blood stasis in time. Conclusion the tissue rich pectoralis major myocutaneous flap, whether in overweight / obese male or female patients, has a constant trend of blood vessels. Although the blood supply is abundant and bloated, it is difficult to prepare and repair, but as long as ensure the correct location in the operation, identify the vascular pedicle carefully, operate carefully, monitor closely after the operation and nursing the skin flap to find the complications in time. The myocutaneous flap can still heal well with the wound, so it is still an important flap to repair and reconstruct the head and neck defect.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.91

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