延长下斜方肌皮瓣和胸大肌皮瓣修复复发口腔、口咽癌术后缺损的效果比较

摘要/Abstract

摘要： 目的比较延长下斜方肌皮瓣和胸大肌皮瓣在复发性口腔、口咽癌术后缺损重建中的应用效果。方法选取中山大学孙逸仙纪念医院口腔颌面外科39例复发口腔癌或口咽癌病例,挽救性手术切除后,以延长下斜方肌皮瓣或胸大肌皮瓣修复术后缺损,其中延长下斜方肌皮瓣修复21例,胸大肌皮瓣修复18例。采用SPSS 12.0软件包对数据进行统计学分析。结果延长下斜方肌皮瓣可制备的血管蒂比胸大肌皮瓣更长,且延长下斜方肌皮瓣可制备的皮岛长度和宽度均大于胸大肌皮瓣。术后所有患者均未出现严重并发症,延长下斜方肌皮瓣比胸大肌皮瓣局部坏死几率更低。结论延长下斜方肌皮瓣比胸大肌皮瓣蒂更长且皮岛面积更大,是修复复发口腔、口咽癌术后颌面部巨大缺损的最佳方法之一。

关键词: 延长下斜方肌皮瓣, 胸大肌皮瓣, 口腔鳞癌, 口咽鳞癌, 肿瘤复发, 挽救性手术

Abstract: PURPOSE: To compare the use of extended vertical lower trapezius island myocutaneous flap (TIMF) and pectoralis major myocutaneous flap (PMMF) in reconstruction of large defect after radical surgery of advanced recurrent oral and oropharyngeal squamous cell carcinoma (SCC). METHODS: A total of 39 patients with advanced recurrent oral and oropharyngeal SCC underwent salvage surgery followed by placement of either an extended lower vertical TIMF or PMMF for reconstruction. Twenty-one patients received extended lower vertical TIMFs, whereas 18 received PMMFs. SPSS 12.0 software package was used for statistical analysis. RESULTS: The pedicle length of the TIMF was longer than that of the PMMF, and the skin paddle of the TIMF was both wider and longer than the PMMF. No major complications developed in any of the patients. The TIMF group experienced a lower rate of minor flap failure than the PMMF group. CONCLUSIONS: Extended vertical lower TIMF, which has a longer pedicle flap and a larger skin paddle than a PMMF, is an optimal flap for reconstruction of major defects.

Key words: Trapezius flap, Pectoralis major flap, Oral cavity, Squamous cell carcinoma, Oropharynx, Tumour recurrence, Salvage surgery

中图分类号:

R782.2

王友元, 李群星, 张大明, 钟江龙, 范松, 林钊宇, 叶剑涛, 陈伟良. 延长下斜方肌皮瓣和胸大肌皮瓣修复复发口腔、口咽癌术后缺损的效果比较[J]. 中国口腔颌面外科杂志, 2016, 14(4): 352-356.

WANG You-yuan, LI Qun-xing, ZHANG Da-ming, ZHONG Jiang-long, FAN Song, LIN Zhao-yu, YE Jian-tao, CHEN Wei-liang. Extended vertical lower trapezius island myocutaneous flap and pectoralis major myocutaneous flap used for reconstruction of patients with recurrent oral and oropharyngeal cancer[J]. China J Oral Maxillofac Surg, 2016, 14(4): 352-356.

参考文献

[1] Chen W, Yang Z, Zhang D, et. al. Second salvage surgery with extended vertical lower trapezius island myocutaneous flap reconstruction for advanced re-recurrent oral and oropharyngeal squamous cell carcinoma [J]. Int J Oral Maxillofac Surg, 2014, 43(5): 531-538.
[2] Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck [J]. Plast Reconstr Surg, 1979, 63(1): 73-81.
[3] Gadre KS, Gadre P, Sane VD, et al. Pectoralis major myocutaneous flap—still a workhorse for maxillofacial reconstruction in developing countries [J]. J Oral Maxillofac Surg, 2013, 71(11): 2005.e1-e10.
[4] Chen WL, Li J, Yang Z, et al. Extended vertical lower trapezius island myocutaneous flap in reconstruction of oral and maxillofacial defects after salvage surgery for recurrent oral carcinoma [J]. J Oral Maxillofac Surg, 2007, 65(2): 205-211.
[5] Chen WL, Zhang B, Wang JG, et. al. Reconstruction of large defects of the neck using an extended vertical lower trapezius island myocutaneous flap following salvage surgery for neck recurrence of oral carcinoma [J]. J Plast Reconstr Aesthet Surg, 2011, 64(3): 319-322.
[6] Mallet Y, El Bedoui S, Penel N, et al. The free vascularized flap the pectoralis major pedicled flap options: comparative results of reconstruction of the tongue [J]. Oral Oncol, 2009, 45(12): 1028-1031.
[7] Zhang X, Li MJ, Fang QG, et al. A comparison between the pectoralis major myocutaneous flap and the free anterolateral thigh perforator flap for reconstruction in head and neck cancer patients: assessment of the quality of life [J]. J Craniofac Surg, 2014, 25(3): 868-871.
[8] O'Neill JP, Shine N, Eadie PA, et al. Free tissue transfer versus pedicled flap reconstruction of head and neck malignancy defects [J]. Ir J Med Sci, 2010, 179(3): 337-343.
[9] Avery CM, Crank ST, Neal CP, et al. The use of the pectoralis major flap for advanced and recurrent head and neck malignancy in the medically compromised patient [J]. Oral Oncol, 2010, 46(11): 829-833.
[10] Schneider DS, Wu V, Wax MK. Indications for pedicled pectoralis major flap in a free tissue transfer practice [J]. Head Neck, 2012, 34(8): 1106-1110.
[11] Kekatpure VD, Trivedi NP, Manjula BV, et al. Pectoralis major flap for head and neck reconstruction in era of free flaps [J]. Int J Oral Maxillofac Surg, 2012, 41(4): 453-457.
[12] Avery CM, Crank ST, Neal CP, et al. The use of the pectoralis major flap for advanced and recurrent head and neck malignancy in the medically compromised patient [J]. Oral Oncol, 2010, 46(11): 829-833.
[13] Avery CM, Gandhi N, Peel D, et al. Indications and outcomes for 100 patients managed with a pectoralis major flap within a UK maxillofacial unit [J]. Int J Oral Maxillofac Surg, 2014, 43(5): 546-554.
[14] Chen WL, Deng YF, Peng GG, et al. Extended vertical lower trapezius lsland myocutaneous flap for reconstruction of cranio-maxillofacial defects [J]. Int J Oral Maxillofac Surg, 2007, 36(2): 165-170.
[15] Koh KS, Eom JS, Kirk I, et al. Pectoralis major musculocutaneous flap in oropharyngeal reconstruction: revisited [J]. Plast Reconstr Surg, 2006, 118(5): 1145-1149.
[16] Depprich RA, Handschel JG, Braunstein S, et al. Breast carcinoma in a pectoralis major myocutaneous flap used for reconstruction of the oral cavity: a case report and review of the literature [J]. Oral Oncol Extra, 2005, 41(9): 238-241.
[17] Mohan AM, Balaguhan B, Krishna V, et al. Squamous cell carcinoma of the pectoralis major myocutane ous flap donor site [J]. J Oral Maxillofac Surg, 2014,72(7): 1425-1431.