【摘要】 目的探讨联合应用游离组织瓣和带蒂胸大肌皮瓣移植修复大型头颈部缺损的可靠性和应用价值。方法对9例联合应用游离组织瓣和带蒂胸大肌皮瓣行头颈部缺损修复的患者作回顾性研究,分析头颈部缺损的类型、受区血管情况、游离组织瓣的类型、组织瓣成活情况及术后并发症,探讨有可能影响组织瓣成活的因素。结果9例患者采用的游离瓣包括前臂瓣6例、腓骨瓣2例和大腿前外侧皮瓣1例。1例前臂皮瓣于术后24h出现静脉危象,经紧急手术探查和重新吻合血管后获得成活,其余游离瓣术后均未出现血管危象,全部成活。9例患者的9块胸大肌皮瓣也均获得成活。结论游离组织瓣联合带蒂胸大肌皮瓣移植主要适用于无法或不适合作双游离瓣移植的大型头颈部缺损修复,安全性较高,在大型头颈部复合缺损的修复中有一定的应用价值。更多还原

【Abstract】 Objective To analyze the value and reliability of combined free flap and pedicled pectoralis major myocutaneous flap in the reconstruction of extensive composite head and neck defects. Methods Nine consecutive cases of combined free flap and pedicled pectoralis major myocutaneous flap transfers for extensive head and neck defects from March 2002 to April 2005 were reviewed. Data concerning the operation included defect description, type of free flap, recipient vessel and complications. Results There were 9 cases in this group, with 7 males and 2 females. Among the 9 free flaps, there were 6 radial forearm flaps, two fibula flaps, and one anterolateral thigh flap. The overall flap survival rate was 100% (all of 18 flaps), without partial or total flap necrosis. One radial forearm flap developed venous thrombosis 24 hours after operation, but salvaged by emergent exploration and re- anastomosis of veins. The overall complication rate was 44.4%. Conclusion In selected cases, the combined free flap and pedicled pectoralis major myocutaneous flap method provided satisfactory reconstruction for extensive head and neck defect, and simplified the double free flap method.更多还原