Zbar R I, Funk G F, McCulloch T M, Graham S M, Hoffman H T
Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
Head Neck. 1997 Aug;19(5):412-8. doi: 10.1002/(sici)1097-0347(199708)19:5<412::aid-hed8>3.0.co;2-2.
The pectoralis major myofascial (PMMF) unit is rapidly mobilized, reliable, and extremely useful in a number of clinical situations calling for vascularized soft-tissue coverage in the head and neck. Although free-tissue transfer has emerged as the preferred method of reconstruction for a large variety of defects in the head and neck, the pectoralis major muscle should be considered when vascularized soft-tissue coverage is required in this area.
A retrospective chart review of 24 PMMF flaps performed at the University of Iowa Hospitals and Clinics between January 1, 1991, and May 1, 1996, was undertaken. Outcomes were evaluated relative to accomplishing the established preoperative surgical goals.
Utilization of the PMMF flap was grouped according to four primary indications: (1) protection of threatened great vessels or free flap vascular pedicles in situations of wound breakdown due to fistula or infection (7 cases); (2) vascularized soft-tissue coverage of great vessels or free-flap vascular pedicles and prevention of potential wound breakdown in surgical defects in which compromised healing was anticipated (7 cases); (3) closure of small pharyngeal defects (2 cases); or (4) vascularized coverage of the mandible following debridement for osteoradionecrosis (8 cases). The PMMF flap was 100% successful when the surgical goal was to protect exposed vascular structures and promote wound healing in the presence of fistula or infection. The PMMF flap was 100% successful in the protection of vascular structures and prevention of wound breakdown in cases where compromised wound healing was anticipated. The PMMF flap provided closure, and a vascularized surface for mucosalization, when used to primarily reconstruct small pharyngeal defects. The PMMF flap provided definitive closure in 5 of 8 (62.5%) cases of osteoradionecrosis of the mandible when it was used to invest the remaining mandibular bone. Three of 8 cases (37.5%) required further surgical management and were considered failures. An acceptable cosmetic outcome was obtained in women undergoing this procedure by using an inframammary incision. The preoperative goal of the PMMF flap procedure was met in 21 of 24 (87.5%) cases. There was a major complication rate of 12.5% as well as a minor complication rate of 12.5%.
In cases requiring the protection of vital vascular structures from infection, salivary secretions or skin flap breakdown, the PMMF flap should be considered. The PMMF flap is an excellent reconstructive option in selected clinical situations, where vascularized soft-tissue coverage is required in the head and neck.
胸大肌肌筋膜（PMMF）单元可快速调动，可靠且在许多需要对头颈部进行带血管软组织覆盖的临床情况中极为有用。尽管游离组织移植已成为头颈部多种缺损重建的首选方法，但在该区域需要带血管软组织覆盖时，应考虑胸大肌。
对1991年1月1日至1996年5月1日在爱荷华大学医院及诊所进行的24例PMMF皮瓣手术进行回顾性图表分析。根据实现既定术前手术目标评估结果。
PMMF皮瓣的应用根据四个主要适应证进行分组：（1）在因瘘管或感染导致伤口裂开的情况下保护受威胁的大血管或游离皮瓣血管蒂（7例）；（2）对大血管或游离皮瓣血管蒂进行带血管软组织覆盖，并预防预期愈合不良的手术缺损中潜在的伤口裂开（7例）；（3）闭合小的咽部缺损（2例）；或（4）对放射性骨坏死清创后的下颌骨进行带血管覆盖（8例）。当手术目标是在存在瘘管或感染的情况下保护暴露的血管结构并促进伤口愈合时，PMMF皮瓣成功率为100%。在预期伤口愈合不良的情况下，PMMF皮瓣在保护血管结构和预防伤口裂开方面成功率为100%。当用于一期重建小的咽部缺损时，PMMF皮瓣可实现闭合，并提供一个用于黏膜化的带血管表面。当用于包裹剩余下颌骨时，PMMF皮瓣在8例下颌骨放射性骨坏死病例中有5例（62.5%）实现了确定性闭合。8例中有3例（37.5%）需要进一步手术处理，被视为失败。通过采用乳房下切口，接受该手术的女性获得了可接受的美容效果。24例中有21例（87.5%）达到了PMMF皮瓣手术的术前目标。主要并发症发生率为12.5%，次要并发症发生率为12.5%。
在需要保护重要血管结构免受感染、唾液分泌或皮瓣裂开影响的情况下，应考虑PMMF皮瓣。在头颈部需要带血管软组织覆盖的特定临床情况下，PMMF皮瓣是一种出色的重建选择。
