Guedon C E, Marmuse J P, Gehanno P, Barry B
Department of Head and Neck Surgery, Bichat-Claude Bernard University Hospitals, Paris, France.
Am J Surg. 1994 Nov;168(5):491-3. doi: 10.1016/s0002-9610(05)80108-4.
The reconstruction of extensive neck defects with minimum deformity and rapid return to normal food intake is successfully achieved by the use of gastro-omental flaps. We report a series of 18 patients who underwent such reconstructive surgery for major full-thickness defects involving the skin in addition to the larynx and pharynx. Fifteen patients had earlier undergone radiotherapy and 3 chemoradiotherapy; 14 of them had undergone previous surgery. The cause of the defect was tumor recurrence in 10 patients, a pharyngostoma in 6, and postoperative cellulitis in 2.
Harvesting of the flap included elevation of a segment of the greater curvature of the stomach together with the omentum pediculated on the right gastroepiploic vessels. In 8 patients with a circumferential pharyngeal defect, the graft was used in the form of a tube; in the other 10, the graft was converted into a patch to reconstruct the missing anterior pharyngeal wall. In all cases, the omentum was used to fill in the defect. In 5 patients, neck vessels were chosen as recipient vessels, and axillary vessel systems were selected in 13 because the surgical approach to neck vessels was contraindicated.
There was no instance of total flap necrosis. Fifteen patients had an uneventful postoperative course, and oral food intake was begun on the 15th day. The remaining 3 patients developed fistulas, which healed spontaneously. The omentum was left to granulate in all patients, and skin grafts were required in 5 patients only. No abdominal complications occurred in any patients.
These results suggest that gastro-omental free flaps are a method of choice that should be seriously considered for the reconstruction of full-thickness defects of the neck.
通过使用胃网膜瓣可成功实现广泛颈部缺损的重建，使畸形最小化并能迅速恢复正常饮食摄入。我们报告了一系列18例患者，他们因涉及皮肤以及喉和咽的大面积全层缺损而接受了此类重建手术。15例患者先前接受过放疗，3例接受过放化疗；其中14例曾接受过手术。缺损原因包括10例肿瘤复发、6例咽瘘和2例术后蜂窝织炎。
切取皮瓣包括提起胃大弯的一段以及以胃网膜右血管为蒂的网膜。8例环形咽缺损患者中，移植物采用管状形式；在另外10例患者中，移植物被制成补片以重建缺失的咽前壁。在所有病例中，网膜用于填充缺损。5例患者选择颈部血管作为受区血管，13例选择腋血管系统，因为颈部血管的手术入路禁忌。
没有出现皮瓣完全坏死的情况。15例患者术后恢复顺利，术后第15天开始经口进食。其余3例患者出现瘘管，但均自行愈合。所有患者的网膜均任其肉芽生长，仅5例患者需要植皮。所有患者均未发生腹部并发症。
这些结果表明，胃网膜游离皮瓣是颈部全层缺损重建应认真考虑的一种首选方法。
