Peng Y, Li Z, Song D J
Department of Otolaryngology, Changsha Fourth Hospital, Changsha 410008, China.
Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha 410008, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 Jan 7;58(1):37-41. doi: 10.3760/cma.j.cn115330-20220530-00314.
To investigate the anatomical classification of adductor magnus perforator flap and its application in head and neck reconstruction. From January 2017 to January 2020, Hunan Cancer Hospital treated 27 cases of oral tumor patients (15 cases of tongue cancer, 9 cases of gingival cancer and 3 cases of buccal cancer), including 24 males and 3 females, aged 31-56 years old. The course of disease was 1-12 months. Secondary soft tissue defects with the sizes of 5.0 cm × 3.5 cm to 11.0 cm × 8.0 cm were left after radical resection of the tumors, and were repaired with free adductor magnus perforator flaps. The flaps based on the origing locations of perforator vessels were divided into three categories: ① intramuscular perforator: vessel originated between the gracilis muscle and the adductor magnus or passed through a few adductor magnus muscles; ② adductor magnus middle layer perforator: vessel run between the deep and superficial layers of adductor magnus; ③ adductor magnus deep layer perforator: vessel run between the deep layer of adductor magnus and the semimembranous muscle. Descriptive analysis was used in this research. Perforator vessels of adductor magnus were found in all cases, with a total of 62 perforator branches of adductor magnus. The anatomical classification of the perforator vessels was as follows: 12 branches for class ①, 31 branches for class ② and 19 branches for class ③. The vascular pedicles of the free adductor major perforator flaps included type ① for 3 cases, type ② for 16 cases and type ③ for 8 cases. All 27 flaps survived and the donor sites were closed directly. In 18 cases, the perforator arteries and the venae comitan were respectively anastomosed with the superior thyroid arteries and veins. In 9 cases, the pedicle arteries and the venae comitan were respectively anastomosed with the facial arteries and veins. Follow up for 12-40 months showed that the appearances of the flaps and the swallowing and language functions of patients were satisfactory, apart from linear scars were left in the donor sites with no significant affect on the functions of thigh. Local recurrence occurred in 3 cases and radical surgeries were performed again followed by repairs with pedicled pectoralis major myocutaneous flaps. Cervical lymph node metastasis occurred in 2 cases and cervical lymph node dissection was performed again. The adductor magnus perforator flap has soft texture, constant perforator vessel anatomy, flexible donor location and harvesting forms, and less damage to the donor site. It is an ideal choice for postoperative reconstruction in head and neck tumors.
探讨大收肌穿支皮瓣的解剖学分类及其在头颈部重建中的应用。2017年1月至2020年1月，湖南省肿瘤医院收治口腔肿瘤患者27例（舌癌15例、牙龈癌9例、颊癌3例），其中男性24例，女性3例，年龄31 - 56岁。病程1 - 12个月。肿瘤根治性切除后遗留5.0 cm×3.5 cm至11.0 cm×8.0 cm大小的继发软组织缺损，采用游离大收肌穿支皮瓣修复。根据穿支血管的起始部位将皮瓣分为三类：①肌内穿支：血管起源于股薄肌与大收肌之间或穿过部分大收肌；②大收肌中层穿支：血管走行于大收肌深浅两层之间；③大收肌深层穿支：血管走行于大收肌深层与半膜肌之间。本研究采用描述性分析。所有病例均发现大收肌穿支血管，共62支大收肌穿支分支。穿支血管的解剖学分类如下：①类12支，②类31支，③类19支。游离大收肌主要穿支皮瓣的血管蒂类型①3例，类型②16例，类型③8例。27块皮瓣全部成活，供区直接缝合。18例将穿支动脉与伴行静脉分别与甲状腺上动静脉吻合；9例将蒂部动脉与伴行静脉分别与面动静脉吻合。随访12 - 40个月，结果显示皮瓣外观及患者吞咽、语言功能满意，供区仅留线性瘢痕，对大腿功能无明显影响。3例局部复发，再次行根治性手术，术后采用带蒂胸大肌肌皮瓣修复；2例发生颈部淋巴结转移，再次行颈部淋巴结清扫术。大收肌穿支皮瓣质地柔软，穿支血管解剖恒定，供区位置灵活、取材方式多样，对供区损伤小，是头颈部肿瘤术后重建的理想选择。
