Rubin J S
Department of Otorhinolaryngology, Montefiore Medical Center, Bronx, New York 10467.
J Laryngol Otol. 1989 Mar;103(3):302-5. doi: 10.1017/s002221510010876x.
Post-laryngectomy pharyngeal fistulization is an unpleasant occurrence. Presented herein is the author's approach to this problem, along with two cases in which closure was effected by sternocleidomastoid (SCM) myoplasty. SCM myocutaneous flaps have previously been considered for pharyngocutaneous fistulae and then disregarded due to the doubtful nature of the blood supply to the skin. The SCM myoplasty obviates this problem as it relies on muscle rather than skin. SCM myoplasty has been used as a bolster in pharyngeal reconstruction after the pharynx has been closed by pharyngeal mucosal advancement or rotation. The author has extended this idea utilizing the raw muscle of the SCM to directly reconstruct the defect in fistulae deemed too large for primary closure. Anatomical, oncological and technical considerations are discussed, as well as the author's protocol for post-laryngectomy pharyngocutaneous fistulae.
喉切除术后咽瘘形成是一件令人不快的事情。本文介绍了作者针对这一问题的处理方法，以及两例通过胸锁乳突肌（SCM）肌成形术实现瘘口闭合的病例。胸锁乳突肌肌皮瓣此前曾被考虑用于咽皮肤瘘，但由于其皮肤血供性质存疑而被摒弃。胸锁乳突肌肌成形术避免了这一问题，因为它依靠的是肌肉而非皮肤。胸锁乳突肌肌成形术已被用作在通过咽黏膜推进或旋转关闭咽腔后进行咽重建的支撑手段。作者拓展了这一理念，利用胸锁乳突肌的裸露肌肉直接修复那些被认为太大而无法一期闭合的瘘口缺损。文中讨论了解剖学、肿瘤学和技术方面的考虑因素，以及作者针对喉切除术后咽皮肤瘘的方案。
