女性之胸大肌肌皮瓣

Pectoralis Major Myocutaneous Flap for Females

姚程豐(Cheng-Feng Yao) ； 花俊宏(Chun-Hung Hua) ； 蔡銘修(Ming-Hsui Tsai)

《台灣耳鼻喉頭頸外科雜誌》 39卷1期 (2004/01) Pp. 33-38

https://doi.org/10.6286/2004.39.1.33

摘要

胸大肌肌皮瓣（pectoralis major myocutaneous flap）應用於頭頸部腫瘤切除後的重建手術，下從胸壁上達眼窩，幾乎涵蓋整個頭頸區域軟組織、皮膚或黏膜的取代，甚至可配合肋骨骨肌皮瓣做下頜骨缺損之修補手術。雖然具有手術容易、可一次完成、皮瓣可塑性佳且存活率高等優點，但是術後卻在胸前遺留大量疤痕，造成乳房變形與不對稱而令一般女性病患難以接受。
本院從1998年7月至2002年7月間共施行胸大肌肌皮瓣手術75例，其中3例為女性病患。針對胸大肌肌皮瓣對女性乳房的影響，我們在皮膚切線的設計上特別作了些修正: 皮膚島瓣位置的選擇貼近乳房下緣取半月形島瓣，皮膚切線則沿乳房下皺褶往外上延伸。如此則可儘量增加肌皮瓣延展長度以及減少術後乳頭位置的偏移並將術後疤痕隱藏在乳房下皺褶，讓乳房自然地遮掩疤痕。胸大肌肌皮瓣在女性病患的應用有其先天的限制，但是只要我們慎選病人，並且在皮膚切線的設計上稍作修正還是可以兼顧到皮瓣存活率與術後的整體美觀。

關鍵字

胸大肌肌皮瓣

並列摘要

Despite of the increased use of microvascular flaps in the recent years, the pectoralis major myocutaneous flap (PMMF) remains a popular reconstructive choice for large soft tissue defects following extirpation of head and neck tumor. But some of problems limit the clinical application in female patients. These include excessive bulkiness and the unacceptable postoperative cosmetics—distortion of breast.
We experienced 75 patients undergoing PMMF reconstruction immediately following surgical ablation of malignant tumors in the head and neck between July 1998 and July 2002. Of these patients, 3 were female. Special considerations to the postoperative cosmetology, modifications of the incision design of the skin island of all three female patients were made to reach an acceptable cosmetic appearance of the donor sites. Instead of conventional skin island location and skin incision we harvested the semilunar shaped paddle from the inferior border with the axis paralleled to the inframammary fold and extend the skin incision along the inframammary fold laterally and superiorly until the anterior axillary line.
These modifications make the suture line exactly fit the inframammary fold and the subsequent scars could be hidden naturally by the breast resulting more cosmetic satisfaction in female patients.

並列關鍵字

pectoralis major myocutaneous flap