Song Ming, Chen Wen-Kuan, Guo Zhu-Ming, Li Qiu-Li
State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, PR China.
Ai Zheng. 2008 Jan;27(1):58-61.
BACKGROUND & OBJECTIVE: Total or partial defects after one-stage reconstruction for advanced head and neck cancer is a challenging problem in head and neck surgery. Pectoralis major myocutaneous flap (PMMF) plays an irreplaceable role in head and neck reconstruction surgery. This study was to define operational indications for using PMMF in head and neck defect reconstruction, and summarize how to further increase the success rate.
From Jan. 2004 to Jan. 2007, 22 patients who underwent head and neck defect reconstruction using PMMF were investigated. Of the 22 patients, 8 had cervical skin defect, 5 had tongue defect, 4 had oropharynx defect, 3 had base of tongue defect, and 2 had hypopharynx defect; 13 had the flap passed through the subclavicular tunnel to the head and neck area, and 9 had the flap transposed over clavicle to the neck. The reconstruction size ranged from 15 cm x 12 cm to 8 cm x 5 cm.
No patient died during operation, 1 had total flap necrosis, and 1 had partial flap necrosis. The success rate of reconstruction was 95.5%. Postoperative complications occurred in 2 (9.1%) patients: 1 had wound hematocele, and 1 had fistula at the base of the tongue.
PMMF is a good donor for head and neck reconstruction, especially for resurfacing huge cervical skin defect. The approach of passing the vascular pedicle through a subclavicular tunnel will not only enhance the arc of rotation, but also help to prevent compression of the vascular pedicle.
晚期头颈癌一期重建术后的全层或部分缺损是头颈外科中一个具有挑战性的问题。胸大肌肌皮瓣（PMMF）在头颈重建手术中发挥着不可替代的作用。本研究旨在明确PMMF在头颈缺损重建中的手术适应证，并总结如何进一步提高成功率。
对2004年1月至2007年1月期间22例行PMMF修复头颈缺损的患者进行研究。22例患者中，颈部皮肤缺损8例，舌缺损5例，口咽缺损4例，舌根缺损3例，下咽缺损2例；皮瓣经锁骨下隧道至头颈区13例，经锁骨上转移至颈部9例。修复面积为15 cm×12 cm至8 cm×5 cm。
术中无患者死亡，1例皮瓣全部坏死，1例部分坏死。修复成功率为95.5%。术后并发症2例（9.1%）：1例伤口积血，1例舌根瘘。
PMMF是头颈重建的良好供区，尤其适用于修复巨大颈部皮肤缺损。血管蒂经锁骨下隧道的方法不仅可增加旋转弧度，还有助于防止血管蒂受压。
