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目的介绍应用垂直斜方肌肌皮瓣同期修复头颈部肿瘤切除术后软组织缺损的临床经验。方法 2008年6月-2010年2月,采用垂直斜方肌肌皮瓣同期修复头颈部肿瘤切除术后软组织缺损12例。其中男9例,女3例;年龄32～76岁,中位年龄54岁。眼眶区基底细胞癌2例,腮腺鳞状细胞癌侵及皮肤2例,颌下腺恶性混合瘤2例,鼻咽癌放疗后颈部淋巴结转移2例,舌鳞状细胞癌1例,枕部皮肤鳞状细胞癌3例。患者肿瘤TNM分期均为T3或T4病变。肿瘤切除术后软组织缺损范围13 cm×6 cm～25 cm×13 cm,采用大小为14 cm×7 cm～26 cm×14 cm的垂直斜方肌肌皮瓣修复缺损。供区直接拉拢缝合。结果术后切口均Ⅰ期愈合,无感染等并发症发生。11例肌皮瓣全部成活,1例术后10 d肌皮瓣边缘坏死,经换药后延期愈合。2例术后7 d拔除引流后1周内背部供区出现少量皮下积血、积液,经抽吸加压包扎后皮瓣愈合。11例患者术后获随访,随访时间1～3年,平均2年。9例患者随访期内未见肿瘤复发,肌皮瓣外形满意,双肩外展功能良好;术后3个月1例眼眶区基底细胞癌复发;1例鼻咽癌患者术后12个月死于脑转移。结论垂直斜方肌肌皮瓣手术操作简便,组织瓣有足够长度,血供丰富,可满足头颈部软组织缺损的修复。
Objective To introduce the clinical experience of using vertical trapezius muscle myocutaneous flap to repair soft tissue defects after head and neck tumor resection. Methods From June 2008 to February 2010, 12 cases of soft tissue defect after head and neck tumor resection were treated with vertical trapezius myocutaneous flap. Including 9 males and 3 females; aged 32 to 76 years, the median age of 54 years. Orbital basal cell carcinoma in 2 cases, parotid squamous cell carcinoma invaded and skin in 2 cases, submandibular gland malignant mixed tumor in 2 cases, nasopharyngeal carcinoma after radiotherapy cervical lymph node metastasis in 2 cases, tongue squamous cell carcinoma in 1 case, occipital skin squamous cell carcinoma 3 cases of somatic cell carcinoma. TNM staging of patients with tumors were T3 or T4 lesions. The extent of soft tissue defect after tumor resection was 13 cm × 6 cm ~ 25 cm × 13 cm, and the defect was repaired by the vertical trapezius muscle myocutaneous flap of 14 cm × 7 cm ~ 26 cm × 14 cm. For the area directly draw suture. Results All the incisions healed in the first stage and no complications such as infection occurred. All 11 myocutaneous flaps survived, and 1 had a marginal necrosis of the musculocutaneous flap 10 d after operation, and healed postoperatively. In 2 cases, a small amount of subcutaneous hemorrhage and effusion occurred in the donor area of the back for 1 week after drainage and drainage, and the flap was healed by suction and compression. Eleven patients were followed up for 1-3 years with an average of 2 years. Nine patients had no tumor recurrence during the follow-up period, the shape of myocutaneous flap was satisfactory, and the shoulder abduction function was good. One case had orbital basal cell carcinoma recurrence at 3 months after operation. One case died of nasal pharyngeal carcinoma 12 months after operation Brain metastases. Conclusion Vertical trapezius myocutaneous flap operation is simple, the flap has sufficient length, rich in blood supply, can meet the head and neck soft tissue defect repair.