Song Dajiang, Li Zan, Zhou Xiao, Zhang Yixin, Peng Xiaowei, Zhou Bo, Lü Chunliu, Yang Lichang, Peng Wen
Department of Tumor Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P. R. China.
Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Oct 8;30(10):1249-1252. doi: 10.7507/1002-1892.20160255.
To explore the effectiveness of pedicled thoracoacromial artery perforator (TAAP) flap for pharyngocutaneous fistula repair after total laryngectomy and radiotherapy.
Between February 2012 and January 2015, TAAP flap was used to repair pharyngocutaneous fistula after total laryngectomy and radiotherapy in 8 patients. The eight patients were male, aged from 46 to 72 years (mean, 51.8 years). The disease duration was 8-62 months (mean, 27.5 months). Fistula size ranged from 4.0 cm×2.5 cm to 6.0 cm×4.0 cm and the skin defect size ranged from 4.0 cm×3.0 cm to 6.0 cm×4.0 cm. The flap size ranged from 7.0 cm×4.0 cm×0.3 cm to 9.5 cm×6.0 cm×0.5 cm. The length of pedicle was (8.3±0.5)mm. The distance from pivot point of flap to central point of recipient site was (94.5±1.9) mm.
All 8 flaps survived and all incisions healed smoothly. The hospitalization time was 7-14 days (mean, 9.6 days). The barium meal examination showed no fistula or stenosis. The patients were followed up 8-42 months (mean, 28.5 months). During follow-up, the neck appearance was good, and no fistulas or stenosis occurred. Only linear scars were observed at the donor sites, pectoralis major muscle function was normal in all patients.
Pharyngocutaneous fistula should be repaired as early as possible after total laryngectomy. TAAP flap is suitable for the reconstruction of pharyngocutaneous fistula after total laryngectomy.
探讨带蒂胸肩峰动脉穿支（TAAP）皮瓣修复全喉切除术后放疗后咽瘘的有效性。
2012年2月至2015年1月，8例全喉切除术后放疗后咽瘘患者采用TAAP皮瓣修复。8例患者均为男性，年龄46～72岁（平均51.8岁）。病程8～62个月（平均27.5个月）。瘘口大小为4.0 cm×2.5 cm至6.0 cm×4.0 cm，皮肤缺损大小为4.0 cm×3.0 cm至6.0 cm×4.0 cm。皮瓣大小为7.0 cm×4.0 cm×0.3 cm至9.5 cm×6.0 cm×0.5 cm。蒂长为（8.3±0.5）mm。皮瓣旋转点至受区中心点的距离为（94.5±1.9）mm。
8例皮瓣全部成活，切口均顺利愈合。住院时间7～14天（平均9.6天）。钡餐检查未见瘘口或狭窄。患者随访8～42个月（平均28.5个月）。随访期间，颈部外观良好，未出现瘘口或狭窄。供区仅见线状瘢痕，所有患者胸大肌功能正常。
全喉切除术后应尽早修复咽瘘。TAAP皮瓣适合全喉切除术后咽瘘的重建。
