Division of Plastic and Reconstructive Surgery, State University of Campinas, Campinas, SP, 13080-888, Brazil.
Institute for Plastic Surgery, Southern Illinois University, Springfield, IL, 62702, USA.
Sci Rep. 2017 Oct 11;7(1):12960. doi: 10.1038/s41598-017-13428-7.
Well-vascularized composite tissue offers improved outcomes for complex head and neck reconstruction. Patients with vessel-depleted necks and failed reconstructions require alternative reconstructive options. We describe a pedicled internal mammary artery osteomyocutaneous chimeric flap (PIMOC) for salvage head and neck reconstruction. Bilateral dissections of 35 fresh cadavers were performed to study individual tissue components and vascular pedicles to develop the PIMOC technique. The flap was then utilized in a series of patients with vessel-depleted neck anatomy. The PIMOC was dissected bilaterally in all cadavers and there were no statistical differences in vascular pedicle caliber or length with regards to laterality or gender. Five patients subsequently underwent this procedure. The flaps included a vertical rectus abdominis myocutaneous component and a 6 or 7 rib with adjacent muscle and skin to restore bone defects, internal lining, and external coverage. All donor sites were closed primarily. There were no flap losses and all patients gained improvements in facial contour, speech and swallow. Although technically complex, the PIMOC is reproducible and provides a safe and reliable option for salvage head and neck reconstruction. The harvest of the 6 or 7 rib and rectus abdominis muscle renders an acceptable donor site.
富含血管的复合组织为复杂的头颈部重建提供了更好的结果。血管耗竭的颈部和失败的重建患者需要替代的重建选择。我们描述了一种带蒂的内乳动脉肌皮骨复合瓣（PIMOC）用于挽救性头颈部重建。对 35 具新鲜尸体进行双侧解剖，以研究单个组织成分和血管蒂，从而开发出 PIMOC 技术。然后，该皮瓣在一系列血管耗竭颈部解剖的患者中得到了应用。在所有尸体中，PIMOC 均进行了双侧解剖，在侧别或性别方面，血管蒂的口径或长度没有统计学差异。随后有 5 名患者接受了该手术。皮瓣包括垂直腹直肌肌皮瓣和 6 或 7 根肋骨及其相邻的肌肉和皮肤，以修复骨缺损、内衬和外部覆盖。所有供区均直接闭合。无皮瓣丢失，所有患者面部轮廓、言语和吞咽功能均得到改善。尽管技术复杂，但 PIMOC 是可复制的，为挽救性头颈部重建提供了安全可靠的选择。第 6 或 7 根肋骨和腹直肌的采集提供了一个可接受的供区。
