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背景与目的:带蒂胸大肌皮瓣因为具有多种优点一直是头颈部组织缺损修复应用的经典组织瓣。当今,随着显微技术普及和提高,游离组织瓣逐步取代了带蒂组织瓣。然而,临床上并非所有病例均适宜接受游离组织瓣修复手术,邻近带蒂组织瓣更安全可靠。拟通过改进胸大肌皮瓣的制备及修复方法,探讨改良带蒂胸大肌皮瓣在修复头颈部晚期恶性肿瘤术后复杂缺损时的应用。方法:在皮瓣设计方案及制备方法等多方面改进胸大肌皮瓣,修复头颈部晚期恶性肿瘤术后复杂缺损患者51例。结果:51例改良胸大肌皮瓣全部存活,缺损区修复后外形和供区外形情况满意,缺损区功能得到良好的恢复,供区术后功能损伤最小化。结论:胸大肌皮瓣在设计及制备方法等多方面的改良,提高了对头颈部恶性肿瘤术后复杂缺损修复的范围及修复的距离,减少皮瓣坏死的概率,术后供区和受区外形、功能效果满意,目前仍然是头颈部恶性肿瘤术后缺损的重要修复手段之一。
BACKGROUND & OBJECTIVE: Pedunculated Pectoralis major myocutaneous flap has been the classic tissue flap for the repair of head and neck tissue defects due to its multiple advantages. Nowadays, with the popularization and improvement of microscopy, the free tissue flap gradually replaces the pedicle flap. However, not all cases are clinically suitable for the treatment of free flap repair, the pedicle flap is more safe and reliable. To improve the pectoralis major muscle flap preparation and repair methods to explore the modified pedicle pectoralis major flap in the repair of advanced head and neck cancer after the application of complex defects. Methods: Pectoralis major myocutaneous flaps were modified in many aspects, such as skin flap design and preparation methods, and 51 cases of complex defects in advanced malignant tumors of head and neck were repaired. Results: All the 51 cases of pectoralis major myocutaneous flaps survived. The appearance and shape of donor area were satisfactory after defect repair, and the function of defect area was well restored. The functional injury of donor area was minimized. Conclusion: Pectoralis major myocutaneous flap in the design and preparation methods and many other improvements to improve the range of head and neck cancer patients with complex defect repair and repair, reduce the probability of skin flap necrosis, postoperative donor area and subject District shape, functional effect is satisfactory, is still one of the important repair methods of head and neck malignant tumor postoperative defect.