Dejaco Daniel, Rauchenwald Tina, Steinbichler Teresa, Wolfram Dolores, Morandi Evi, Appenroth Elisabeth, Djedovic Gabriel, Pierer Gerhard, Riechelmann Herbert
Department for Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Austria.
Department for Plastic-, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Austria.
Laryngorhinootologie. 2020 Apr;99(4):229-236. doi: 10.1055/a-1099-9688. Epub 2020 Feb 20.
In recurrent hypopharyngeal/laryngeal squamous cell carcinoma after radiation salvage-laryngectomy (salvage-LE) represents the best curative treatment option. Pre-irradiation promotes development of pharyngocutaneous fistulas (pc-fistula). Transfer of unirradiated tissue to the surgical site reduces fistula rate. Frequently, a myocutaneous Pectoralis-major-flap (PMF) is applied. We describe a muscle sparing, myofascial PMF (ms-PMF) and its functional & aesthetic results.
For the ms-PMF, the pectoralis major is exposed via two 8 cm long subclavicular & submammary horizontal incisions. The pectoral branch of the thoracoacromial artery, which represents the blood supply for the ms-PMF, is identified between the clavicular and sternocostal aspect of the muscle. A craniocaudal stripe of the pectoralis major is recovered and supraclaviculary transposed towards the pharynx. The clavicular and sternocostal part of the muscle remain untouched.The clear-margin resection rate (CMRR), mean overall survival (OS), complications, median length of hospital stay, & functional & aesthetic outcome were assessed.
In 25 patients, salvage-LE with ms-PMF was performed. The CMRR was 100 %, median OS 1.3 (follow-up 2.8) years, complications rate 16 % (4 complete lobe necroses, 3 pc-fistulas) and median inpatient stay 20 (11-78) days. Good functional outcome were observed: limitations of oral food intake occurred in 2-, limitations in voice rehabilitation in 3 patients. Wound healing disorders without lobe necrosis were not observed. The aesthetic results were appealing.
The ms-PMF is a less invasive & safe procedure for fistula prophylaxis in salvage-LE with favorable functional & aesthetic results.
在挽救性喉切除术后复发性下咽/喉鳞状细胞癌中，挽救性喉切除术是最佳的治愈性治疗选择。放疗前会促进咽皮肤瘘（pc瘘）的形成。将未受照射的组织转移至手术部位可降低瘘管发生率。通常会应用胸大肌肌皮瓣（PMF）。我们描述了一种保留肌肉的肌筋膜胸大肌肌皮瓣（ms-PMF）及其功能和美学效果。
对于ms-PMF，通过两条8厘米长的锁骨下和乳房下水平切口暴露胸大肌。在肌肉的锁骨和胸骨肋面之间识别出作为ms-PMF血液供应的胸肩峰动脉胸肌支。保留胸大肌的一条头尾方向的条带，并将其锁骨上移位至咽部。肌肉的锁骨部和胸骨肋部保持不动。评估切缘清除率（CMRR）、平均总生存期（OS）、并发症、中位住院时间以及功能和美学结果。
25例患者接受了ms-PMF挽救性喉切除术。CMRR为100%，中位OS为1.3（随访2.8）年，并发症发生率为16%（4例全叶坏死，3例pc瘘），中位住院时间为20（11 - 78）天。观察到良好的功能结果：2例患者存在经口食物摄入受限，3例患者存在语音康复受限。未观察到无叶坏死的伤口愈合障碍。美学效果令人满意。
ms-PMF是一种用于挽救性喉切除术预防瘘管的侵入性较小且安全的手术，具有良好的功能和美学效果。
