Safak T, Akyürek M, Yüksel E, Kayikçioğlu A, Keçik A
Department of Plastic and Reconstructive Surgery, Hacettepe University Medical School, Ankara, Turkey.
Ann Plast Surg. 1998 Aug;41(2):156-61. doi: 10.1097/00000637-199808000-00007.
The reconstruction of soft-tissue defects in the head and neck region with the latissimus dorsi musculocutaneous pedicled flap is traditionally carried out with dissection of a transaxillary subcutaneous tunnel, which may result in compression of the vascular pedicle in the tunnel, a contour deformity of the neck, or morbidity to the tissues in the axilla and the neck (such as hematoma and seroma). Furthermore, the flaps are often bulky and require secondary defatting. Loss of the muscle causes contour deformity in the back, and its functional loss may be a concern for the patient. To overcome such drawbacks of the traditional use of the flap, we devised a technique of regional transfer of the latissimus dorsi musculocutaneous pedicled island flap to the head and neck region over a pectoral skin bridge rather than utilizing a transaxillary subcutaneous tunnel. This is a two-stage procedure. During the first stage the musculocutaneous flap is transposed in an extracutaneous route to the recipient site. Following a 3-week neovascularization period, the second stage is performed, during which the muscle is detached from its overlying skin island and replaced in situ. This technique was utilized successfully in 5 patients for reconstruction of various head and neck defects with no complications. We conclude that this staged technique of latissimus dorsi musculocutaneous flap transfer to the head and neck region enables functional preservation of the muscle and overcomes many of the complications of the traditional method of utilizing a transaxillary subcutaneous tunnel.
传统上，采用带蒂背阔肌肌皮瓣修复头颈部软组织缺损时，需经腋窝皮下隧道进行解剖，这可能导致隧道内血管蒂受压、颈部外形畸形，或腋窝及颈部组织出现并发症（如血肿和血清肿）。此外，皮瓣通常较为臃肿，需要二期去脂。肌肉缺失会导致背部外形畸形，其功能丧失可能是患者担忧的问题。为克服传统皮瓣使用方法的这些缺点，我们设计了一种技术，即将带蒂背阔肌肌皮岛状皮瓣经胸壁皮桥转移至头颈部区域，而非利用腋窝皮下隧道。这是一个两阶段的手术。在第一阶段，肌皮瓣经皮外途径转移至受区。经过3周的新生血管形成期后，进行第二阶段手术，在此期间，将肌肉与其上方的皮岛分离并原位复位。该技术成功应用于5例患者，用于修复各种头颈部缺损，无并发症发生。我们得出结论，这种分阶段将背阔肌肌皮瓣转移至头颈部区域的技术能够保留肌肉功能，并克服了传统利用腋窝皮下隧道方法的许多并发症。
