Shah J P, Haribhakti V, Loree T R, Sutaria P
Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
Am J Surg. 1990 Oct;160(4):352-5. doi: 10.1016/s0002-9610(05)80541-0.
A retrospective review of the complications in 211 patients undergoing pectoralis major myocutaneous flap reconstruction is presented. The flap was used for mucosal lining of the oral cavity or oropharynx in 109 patients, for pharyngoesophageal reconstruction in 44, for skin coverage in 47, and for other locations in 14 patients. Flap-related complications developed in 63% of the patients. These included flap necrosis, suture line dehiscence, fistula formation, infection, and hematoma. Analysis of risk factors for the development of flap complications showed the following factors to be significant: age over 70; female gender; nomographic overweight; albumin less than 4 g/dL; use of the flap in reconstruction of the oral cavity after major glossectomy; and presence of other systemic diseases. The median length of hospitalization for those developing complications was 33 days compared with 16 days for those who did not develop any complications. Thirty-five (26%) of the 135 patients developing complications required reoperation and only 2 among these required a second flap. Similarly, only 13 of the 61 patients who developed fistulas required surgical closure.
本文对211例行胸大肌肌皮瓣重建术患者的并发症进行了回顾性分析。109例患者的皮瓣用于口腔或口咽黏膜衬里，44例用于咽食管重建，47例用于皮肤覆盖，14例用于其他部位。63%的患者出现了与皮瓣相关的并发症。这些并发症包括皮瓣坏死、缝线裂开、瘘管形成、感染和血肿。对皮瓣并发症发生的危险因素分析显示，以下因素具有显著性：年龄超过70岁；女性；体重超过标准体重；白蛋白低于4 g/dL；在大舌切除术后使用皮瓣重建口腔；以及存在其他全身性疾病。发生并发症患者的中位住院时间为33天，而未发生任何并发症患者的中位住院时间为16天。135例发生并发症的患者中有35例（26%）需要再次手术，其中只有2例需要第二次皮瓣。同样，61例发生瘘管的患者中只有13例需要手术闭合。
