Kimura A, Nimura Y, Hayakawa N, Yasui A, Torii S
First Department of Surgery, Nagoya University School of Medicine, Japan.
Surg Today. 1994;24(6):548-51. doi: 10.1007/BF01884577.
We report herein the case of a 52-year-old man for whom a split pectoralis major myocutaneous flap was applied at the time of extended radical surgery for esophageal carcinoma with tracheal involvement, to avoid the postoperative complications of anterior tracheostomy such as tracheal necrosis and rupture of the major vessels. Laryngopharyngectomy and extended resection of the proximal trachea was performed through a manubrectomy, leaving the tracheal remnant only 4 cm above the carina. A pectoralis major myocutaneous flap was split into two with one piece being wrapped around the trachea at the anterior mediastinal tracheostomy site, and the other being placed between the trachea and brachiocephalic artery. The postoperative course was uneventful and the patient was discharged from hospital on the 34th postoperative day. A split pectoralis major myocutaneous flap may be effective not only for filling the dead space between the trachea and brachiocephalic artery, but also for reducing tension at the tracheocutaneous anastomosis and protecting against circulatory damage at the mediastinal tracheostomy site to minimize stomal retraction.
我们在此报告一例52岁男性患者，该患者在食管癌侵犯气管的扩大根治手术中应用了胸大肌肌皮瓣分裂瓣，以避免气管造口术的术后并发症，如气管坏死和大血管破裂。通过胸骨上切迹切除术进行喉咽切除术和近端气管扩大切除术，使气管残端仅位于隆突上方4 cm处。将胸大肌肌皮瓣一分为二，一片包裹在前纵隔气管造口处的气管周围，另一片置于气管与头臂动脉之间。术后过程顺利，患者于术后第34天出院。胸大肌肌皮瓣分裂瓣不仅可有效填充气管与头臂动脉之间的死腔，还可减轻气管皮肤吻合处的张力，并防止纵隔气管造口处的循环损伤，以尽量减少造口回缩。
