Demirtas Yener, Yagmur Caglayan, Kelahmetoglu Osman, Demir Ahmet, Guneren Ethem
Department of Plastic, Reconstructive and Aesthetic Surgery, Ondokuz Mayis University Medical School, Samsun, Turkey.
J Craniofac Surg. 2010 May;21(3):771-5. doi: 10.1097/SCS.0b013e3181d7a3cc.
Free-tissue transfer is the reconstruction of choice for most head and neck defects. However, pedicled flaps are also used, especially in high-risk patients and after failure of a free flap. The aim of this study was to compare transaxillary-subclavian pedicled latissimus dorsi musculocutaneous (PLDMC) flap, pectoralis major musculocutaneous flap, and free-tissue transfer for head and neck reconstruction in American Society of Anesthesiologists grades II and III patients. During the last 4 years, PLDMC flap with a modified transaxillary-subclavian route for transfer to the neck was used in 8 patients, pectoralis major musculocutaneous flap was used in 7 patients, and free flaps were used in 12 patients for head and neck reconstructions. These 3 methods were compared regarding the flap dimensions, complications, flap outcome scores, hospitalization time, and cost of the treatment. Mean age of the patients, mean American Society of Anesthesiologists scores, mean dimensions of the flaps, and mean hospitalization time did not differ significantly among the 3 groups. Regarding the operation time, flap complications, outcomes, and cost of total treatment, although statistically not significant, PLDMC group offered the fastest reconstruction with highest flap outcome scores and minimum cost. Free-tissue transfer is the procedure of choice especially for functional reconstruction of head and neck region. Occasionally, there exist cases in whom a pedicled flap could offer a safer option. The PLDMC flap transferred via the transaxillary-subclavian route may be preferred than, with advantages including increased arc of rotation, safer pedicle location, shorter duration of the procedure, and reduced complication rates and costs.
游离组织移植是修复大多数头颈部缺损的首选方法。然而，带蒂皮瓣也会被使用，尤其是在高危患者以及游离皮瓣失败后。本研究的目的是比较经腋-锁骨下带蒂背阔肌肌皮瓣（PLDMC瓣）、胸大肌肌皮瓣和游离组织移植用于美国麻醉医师协会分级为II级和III级患者的头颈部重建效果。在过去4年中，8例患者采用经改良腋-锁骨下途径转移至颈部的PLDMC瓣，7例患者采用胸大肌肌皮瓣，12例患者采用游离皮瓣进行头颈部重建。对这三种方法在皮瓣尺寸、并发症、皮瓣结局评分、住院时间和治疗费用方面进行了比较。三组患者的平均年龄、平均美国麻醉医师协会评分、皮瓣平均尺寸和平均住院时间差异无统计学意义。在手术时间、皮瓣并发症、结局和总治疗费用方面，虽然无统计学意义，但PLDMC组重建速度最快，皮瓣结局评分最高，费用最低。游离组织移植是头颈部功能重建的首选方法。偶尔，也有一些病例带蒂皮瓣可能是更安全的选择。经腋-锁骨下途径转移的PLDMC瓣可能更受青睐，其优点包括增加旋转弧度、蒂部位置更安全、手术时间缩短、并发症发生率和费用降低。
