Elshafiey Maged M, Mebed Ali H, Abd Elmaksoud Abd Elmaksoud M, Attia Amr A
The Department of Surgical Oncology, National Cancer Institute, Cairo University.
J Egypt Natl Canc Inst. 2009 Sep;21(3):249-63.
The aim of this study was to reevaluate the role and effectiveness of pedicled myocutanous and myofascial flaps in reconstruction after resection of head and neck cancer.
This study represents the authors own experience using pedicled myocutanous and myofascial flaps in reconstruction after resection of malignant tumors of different sites in the head and neck. The study included 121 patients with head and neck cancer operated upon at the National Cancer Institute, Cairo University and Alminia Cancer Center over 3 years duration, between July 2005 and the end of July 2008. Four types of flaps were used namely the Pectoralis major (Group I), lower trapezius (Group II), Latissimus dorsi (Group III), and the temporalis ((Group IV) flaps. Utility of the different types of these flaps was reevaluated in terms of indications, advantages, and postoperative complications.
This study included 121 patients, 83 males and 38 females. The mean age was 56 years (range, 14- 65 years). Oral malignancies represented most of the cases (71 cases). Pectoralis major myocutaneous (PMMC) flap was the most commonly used flap (84 cases) and its main indication was oral and pharyngeal defects. Lower trapezius and Latissimus dorsi myocutaneous flaps were used in 14 and 12 cases respectively. Their main indications were tumors in the occiput, ear pinna, parotid and neck regions. The Latissimus dorsi myocutaneous flap was also used for reconstruction of oral and pharyngeal defects in 7 female patients with large breasts and for salvage reconstruction after failure of reconstruction by (PMMC) flap in one patient and for reconstruction after excision of local recurrence on top of previous (PMMC) flap in another patient. Temporalis myofascial flap was used in 12 cases and the main indication was orbital defects. The overall postoperative complications was 19.8% (24/121). It was 20% (17/84) in group I, 28.6% (4/14) in group II, and 25% (3/12) in group III. No flap related complications were reported in group IV. All complications were successfully managed except for one case in (Group I), in which a major flap loss developed and was successfully salvaged by pedicled latissimus dorsi myocutaneous flap.
Pedicled myocutanous and myofascial flaps are still indicated in composite head and neck reconstruction. Their reliability, safety, and high degree of resistance to infection make them essential specially the (PMMC) flap previously described as the spare wheel of head and neck reconstructive surgery. It is suitable for lateral mandibular defects in edentulous patients and in partial pharyngeal defects in irradiated patients. Other pedicled myocutaneous flaps are still valid in certain occasions and sites.
Head and neck cancer - Pectoralis major - Trapezius - Latissimus dorsi - Temporalis myocutaneous - Myofascial flaps - Reconstruction.
本研究旨在重新评估带蒂肌皮瓣和肌筋膜瓣在头颈癌切除术后重建中的作用和效果。
本研究展示了作者自身使用带蒂肌皮瓣和肌筋膜瓣对头颈不同部位恶性肿瘤切除术后进行重建的经验。该研究纳入了2005年7月至2008年7月底这3年间在开罗大学国家癌症研究所和阿尔米尼亚癌症中心接受手术的121例头颈癌患者。共使用了4种皮瓣，即胸大肌瓣（I组）、下斜方肌瓣（II组）、背阔肌瓣（III组）和颞肌瓣（IV组）。从适应证、优点及术后并发症方面重新评估了这些不同类型皮瓣的实用性。
本研究包括121例患者，其中男性83例，女性38例。平均年龄为56岁（范围14 - 65岁）。口腔恶性肿瘤占大多数病例（71例）。胸大肌肌皮瓣（PMMC）是最常用的皮瓣（84例），其主要适应证为口腔和咽部缺损。下斜方肌和背阔肌肌皮瓣分别使用了14例和12例。它们的主要适应证为枕部、耳廓、腮腺和颈部区域的肿瘤。背阔肌肌皮瓣还用于7例乳房较大女性患者的口腔和咽部缺损重建，1例患者PMMC瓣重建失败后的挽救性重建，以及另1例患者先前PMMC瓣基础上局部复发切除后的重建。颞肌肌筋膜瓣使用了12例，主要适应证为眼眶缺损。总体术后并发症发生率为19.8%（24/121）。I组为20%（17/84），II组为28.6%（4/14），III组为25%（3/12）。IV组未报告与皮瓣相关的并发症。除I组1例发生严重皮瓣坏死并通过带蒂背阔肌肌皮瓣成功挽救外，所有并发症均得到成功处理。
带蒂肌皮瓣和肌筋膜瓣仍适用于头颈复合组织重建。它们的可靠性、安全性以及高度抗感染能力使其成为必不可少的手段，特别是之前被描述为头颈重建手术备用方案的PMMC瓣。它适用于无牙患者的下颌骨外侧缺损以及放疗患者的部分咽部缺损。其他带蒂肌皮瓣在某些情况和部位仍有应用价值。
头颈癌 - 胸大肌 - 斜方肌 - 背阔肌 - 颞肌肌皮瓣 - 肌筋膜瓣 - 重建
