Freeman M S, Thomas J R, Zipper J A
Department of Otolaryngology and Neck Surgery, Washington University School of Medicine, St. Louis.
Arch Otolaryngol Head Neck Surg. 1989 Feb;115(2):224-7. doi: 10.1001/archotol.1989.01860260098022.
Complications associated with using the pectoralis major myocutaneous flap increase significantly when a portion of the paddle is randomized and/or the flap is closed under tension. The clavicular division technique was devised to increase the length of the flap to help alleviate this problem. Thirty pectoralis major muscle flaps were dissected in fresh cadavers, using the clavicular division technique. The length of the flap after transposition was measured and recorded before and after clavicular division. The distance from the sternal notch to the clavicular division point was also recorded. The average gain in length was found to be 2.9 cm, with a range of 0.5 cm to 6.5 cm. The clavicular division technique has been used since in five patients. The increase in length has allowed us to discard some or all of the random portion of the flap. We advocate the use of this procedure on any patient where the surgeon is concerned about the viability of the random portion of the flap and/or when it is felt that the tension on the suture line is excessive.
当皮瓣的一部分被随机化处理和/或皮瓣在张力下闭合时，使用胸大肌肌皮瓣相关的并发症会显著增加。设计锁骨分离技术是为了增加皮瓣的长度，以帮助缓解这一问题。使用锁骨分离技术在新鲜尸体上解剖了30个胸大肌肌瓣。在锁骨分离前后测量并记录移位后皮瓣的长度。还记录了从胸骨切迹到锁骨分离点的距离。发现长度平均增加2.9厘米，范围为0.5厘米至6.5厘米。此后，该锁骨分离技术已应用于5例患者。长度的增加使我们能够舍弃皮瓣随机部分的全部或部分。对于外科医生担心皮瓣随机部分的存活能力和/或感觉缝合线张力过大的任何患者，我们主张采用此手术方法。
