Hoffmann T K, Balló H, Hauser U, Bier H
Hals-Nasen-Ohren-Klinik, Universitätsklinik Düsseldorf, Düsseldorf.
HNO. 2006 Jul;54(7):523-7. doi: 10.1007/s00106-005-1344-9.
The pectoralis major myocutaneous flap (PMMF) is an important reconstructive tool for lesions in the head and neck region. Using the supraclavicular route, the PMMF reliably transfers large amounts of well-vascularized skin and muscle into defects of the upper aerodigestive tract. However, limited length and arc of rotation as well as excessive bulk can be problematic.
In the current study, these problems have been addressed by passing the pedicle deeply to the clavicle. Following flap harvest, the pedicle was passed in the subclavicular plane in 15 head and neck cancer patients for primary and secondary reconstruction.
Using this route it was possible to increase the medium length of PMMF to 3 cm compared to the supraclavicular route. No total flap necrosis occurred, however, temporary complications were observed in three of 15 cases (20%)--partial flap necrosis occurred in two cases and fistula formation was observed in one case. This rate is in accordance with complication rates described for the supraclavicular route. However, in long-term follow-ups we observed a fracture of the clavicle in two patients in whom, in contrast to the others, the periostium was not only prepared posteriorly but over the whole circumference.
The subclavicular route for PMMF increases the length and arc of rotation available for reconstruction without compromising vascular supply to a higher degree than with the conventional supraclavicular route. Furthermore, this concept decreases the bulk of the PMMF pedicle which is functionally and cosmetically favourable. Thus, the subclavicular route of PMMF is safe and allows an extension of the reconstructive possibilities.
胸大肌肌皮瓣（PMMF）是头颈部病变重要的重建工具。通过锁骨上途径，PMMF能可靠地将大量血运良好的皮肤和肌肉转移至上消化道缺损处。然而，其长度和旋转弧度有限以及体积过大可能会带来问题。
在本研究中，通过将蒂部深入至锁骨下方解决了这些问题。在15例头颈部癌患者中，于皮瓣切取后，将蒂部经锁骨下平面转移用于一期和二期重建。
与锁骨上途径相比，采用该途径可使PMMF的平均长度增加至3cm。未发生皮瓣完全坏死，但15例中有3例（20%）出现了暂时性并发症——2例发生部分皮瓣坏死，1例出现瘘管形成。该发生率与锁骨上途径所描述的并发症发生率相符。然而，在长期随访中，我们观察到2例患者发生了锁骨骨折，与其他患者不同的是，这2例患者的骨膜不仅在后方进行了剥离，而是在整个周长上进行了剥离。
PMMF的锁骨下途径增加了可用于重建的长度和旋转弧度，且不会比传统的锁骨上途径更严重地损害血供。此外，这一方法减小了PMMF蒂部的体积，在功能和美观方面均有益。因此，PMMF的锁骨下途径是安全的，并扩大了重建的可能性。
