Belli E, Cicconetti A
Cattedra di Chirurgia Maxillo-Facciale, Facoltà di Medicina e Chirurgia, Università degli Studi di Roma La Sapienza, Roma.
Minerva Stomatol. 1994 Apr;43(4):155-65.
The reconstruction of postoperative or post-radiotherapeutic losses of substance in the oral cavity must respond to a number of basic requirements, such as lingual motility, the conservation of the labiogingival groove and adequate drainage of saliva towards the pharynx. This study reports the authors' experience of the reconstruction of the oral cavity using a pectoralis major myocutaneous flap. The identification of anatomic structures, such as the interpectoral compartment which separates the deep folium of the pectoralis major muscle from the clavi-coraco-axillary fascia covering the smaller pectoral muscle. Is indispensable for the correct preparation of the flap. Using an oblique incision along the lateral margin of the pectoralis major muscle the edge of the muscle is revealed and the muscle is separated from the pectoralis minor and from the costosternal structure. The cutaneous island is formed using the deep level of the muscle, and after tunnelling into the subcutaneous plane of the superficial fascia in the deltopectoral region, the flap is overturned to reach the part of the surgical reconstruction. The transposed tissue is sutured at various levels so as to reduce traction on a single component of the flap and to preserve the integrity of the perforating vessels. A total of 16 reconstructions of the oral cavity were performed by the authors using a pedunculated flap from the pectoralis major muscle. Fourteen of these cases were advanced stages of cancer and two were the outcome of radiotherapy. A myofascial flap was used in one case due to the excessive thickness of the subcutaneous panniculus of fat, whereas in the other cases it was not necessary to involve the cutaneous component which guarantees better functional adaptation. The following results were obtained: the metaplasia of the cutaneous surfaces of the flap into a multi-stratified non-keratinized epithelium and the contemporary reduction of cutaneous adnexa. The best functional recovery was observed using myocutaneous flaps compared to the case with the myofascial flap. Other results included: flap versatility in the reconstruction of the region of the retromolar trigonum and antero-lateral oral floor, and lastly the difficulty of performing a correct plastic surgery of the soft palate in those cases with damage in the tonsillar region and consequent rhinolalia. Complications observed, attributable to lesions of the perforating vessels, included two cases of total necrosis of the cutaneous component of the flap and four cases of partial necrosis which were resolved using local reclamation and medication.(ABSTRACT TRUNCATED AT 400 WORDS)
口腔术后或放疗后组织缺损的重建必须满足一些基本要求，如舌的运动功能、唇龈沟的保留以及唾液向咽部的充分引流。本研究报告了作者使用胸大肌肌皮瓣重建口腔的经验。识别解剖结构，如将胸大肌深叶与覆盖胸小肌的锁胸筋膜分隔开的胸肌间室，对于正确制备皮瓣必不可少。沿胸大肌外侧缘做斜切口，显露肌肉边缘，将肌肉与胸小肌及肋胸骨结构分离。利用肌肉深层形成皮岛，在三角肌胸肌区的浅筋膜皮下平面进行隧道分离后，将皮瓣翻转至手术重建部位。在不同层面缝合移位组织，以减少对皮瓣单个成分的牵拉并保留穿支血管的完整性。作者共使用胸大肌带蒂皮瓣进行了16例口腔重建。其中14例为癌症晚期，2例为放疗后结果。1例因皮下脂肪层过厚使用了肌筋膜瓣，而在其他病例中无需包含保证更好功能适应性的皮肤成分。获得了以下结果：皮瓣皮肤表面化生为复层非角化上皮，同时皮肤附属器减少。与使用肌筋膜瓣的病例相比，使用肌皮瓣观察到了最佳的功能恢复。其他结果包括：皮瓣在磨牙后三角和口腔前外侧底部区域重建中的多功能性，以及最后在扁桃体区域受损并伴有鼻音的病例中进行软腭正确整形手术的困难。观察到的并发症，归因于穿支血管损伤，包括2例皮瓣皮肤成分完全坏死和4例部分坏死，通过局部修复和药物治疗得以解决。（摘要截取自400字）
