Rudes Mihael, Bilić Mario, Jurlina Martin, Prgomet Drago
University of Zagreb, Zagreb University Hospital Center, University Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb, Croatia.
Coll Antropol. 2012 Nov;36 Suppl 2:137-42.
The goal of this retrospective study is the evaluation of pectoralis major myocutaneous pedicle flap (PMMPF) reliability in clinical practice based on the analysis of the leading indication and postoperative complications. In the period from 2005 to 2011 at the University Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb University Hospital Center, a total number of 27 PMMPF were used in the treatment of 26 patients. Indications for flap use were upper aerodigestive tract and soft tissue defects following resection of head and neck cancer. One-stage reconstructive technique was used in all patients. Basic demographic data, clinical stage of malignant disease, indications, postoperative complications and management of flap-related complications were systematically analyzed. In 24 cases (89%) leading indication for flap use was primary defect reconstruction following head and neck carcinoma resection and in 3 cases (11%) "salvage" reconstruction following salivary fistula formation and flap-related complications. Tumor invaded skin in 2 (8%) cases, oral cavity in 1 (4%) case, oropharynx in 12 (46%) cases, larynx and/or hypopharynx in 10 (38%) cases and major salivary gland in 1 case (4%). Mucous defect occurred in 21 (81%), cutaneous defect in 3 (11%) and muco-cutaneous defect in 2 patients (8%), respectively. 16 postoperative complications (59.3%) were recorded but only one patient (4%) sustained total flap necrosis. Previously irradiated patients had significantly higher postoperative complication rate. The rate of complications requiring surgical treatment was 25%. Although the overall complication rate was substantially high, PMMPF achieved desired reconstructive goal in 96% cases. Functional and aesthetic assessment was difficult due to the small series of patients. In conclusion, pectoralis major myocutaneous pedicle flap is still safe and acceptable reconstructive method in surgical treatment of patients with head and neck tumors.
本回顾性研究的目的是通过分析主要适应证和术后并发症，评估胸大肌肌皮蒂瓣（PMMPF）在临床实践中的可靠性。2005年至2011年期间，萨格勒布大学医院中心耳鼻喉科及头颈外科大学科室共对26例患者使用了27个胸大肌肌皮蒂瓣。皮瓣使用的适应证为头颈部癌切除术后上消化道和软组织缺损。所有患者均采用一期重建技术。系统分析了基本人口统计学数据、恶性疾病的临床分期、适应证、术后并发症以及皮瓣相关并发症的处理情况。在24例（89%）中，皮瓣使用的主要适应证是头颈部癌切除术后的原发缺损重建，3例（11%）是在唾液瘘形成和皮瓣相关并发症后的“挽救性”重建。肿瘤侵犯皮肤2例（8%）、口腔1例（4%）、口咽12例（46%）、喉和/或下咽10例（38%）、大唾液腺1例（4%）。分别有21例（81%）出现黏膜缺损、3例（11%）出现皮肤缺损、2例（8%）出现黏膜皮肤缺损。记录到16例术后并发症（59.3%），但只有1例患者（4%）发生皮瓣完全坏死。既往接受过放疗的患者术后并发症发生率显著更高。需要手术治疗的并发症发生率为25%。尽管总体并发症发生率相当高，但胸大肌肌皮蒂瓣在96%的病例中实现了预期的重建目标。由于患者数量较少，功能和美学评估较为困难。总之，胸大肌肌皮蒂瓣仍是头颈部肿瘤患者手术治疗中安全且可接受的重建方法。
