Application of Pedicled Pectoralis Major Myocutaneous Flap Tunneled through the Subpectal and Subnuchal Space to Salvage Unsuccessful Reconstructive Surgery in Patients with Head and Neck Cancer

使用帶血管莖胸大肌肌皮瓣穿越胸壁與頸部皮下空間救援不成功的頭頸部腫瘤移除之重建手術

沈仁翔(Jen-Hsiang Shen) ； 王文弘(Wen-Hung Wang) ； 張長正(Chang-Cheng Chang)

《臺灣整形外科醫學會雜誌》 23卷1期 (2014/03) Pp. 23-31

摘要

背景：使用游離皮瓣做為頭頸部腫瘤摘除手術的術後重建已是標準的治療；但是，游離皮瓣仍可能發生併發症或壞死，而導致重建失敗。目的及目標：因此，我們想研究胸大肌肌皮瓣在第一次顯微手術用其他皮瓣不成功時，是否可以成功擔任救援皮瓣的角色。材料及方法：我們蒐集了所有嘉義長庚醫院自2010年八月至2011年十二月接受胸大肌皮瓣作為不成功的游離皮瓣頭頸癌重建手術之救援皮瓣之病患，共七位。這些病患的資料被統計與分析。結果：做為救援之胸大肌肌皮瓣平均面積為98.00±46.68平方公分，平均手術時間為499.71±422.09分鐘。平均加護病房日數為6.00±7.98天，一般病房日數為27.71±35.88天，總住院天數為39.71±35.46天。所有的救援皮瓣都完全存活，除了有一個出現口咽廔管。此廔管也很快地被修補。所有病患都得以出院，並接續他們的癌症治療及追蹤。結論：部分的頭頸部腫瘤的病患，有較差的身體狀況、供血血管缺乏與共病症，會限制游離皮瓣的存活率與應用，我們研究結果顯示胸大肌肌皮瓣是一個可信賴、安全之救援皮瓣選擇。

並列摘要

Background:Microvascular free flap reconstruction after head and neck cancer ablation has become the golden standard. However, there are limited publications about flap choice of salvage flap once the primary free flap failed.Aim and Objectives:We aimed to investigate the role of pectoralis major myocutaneous flap transfer in this incidence.Materials and Methods:This is a retrospective, cross-section review study. Between August 2010 and December 2011, a total of 7 patients who underwent pectoralis major myocutaneous flap transfer for head and neck reconstruction in Chang-Gung Memorial Hospital, Chia-Yi, as a salvage procedure after free flap failure. We record the operation time, ICU stay, ward stay, total admission days, flap survival, complications, and patients' status after the salvage procedure.Results:Salvage PMMF transfers were performed with average area of 98.00±46.68 cm^2, and average operation time was 499.71±442.09 minutes. Average ICU stay was 6.00±7.98 days, and average ward stay was 27.71±35.88 days. The total average hospital stay, including pre-operation, cancer ablation and primary reconstruction was 39.71±35.46 days. All the PMMFs survived completely except in one case of oropharyngeal fistula. This was solved by a tongue flap repair later. All the patients survived, and moved on for oncological therapy.Conclusion:The condition of the patient, such as a lack of recipient vessels, malnutrition, or comorbidity, can limit the use of a free flap for the salvage of failed reconstruction. We propose pectoralis major myocutaneous flap transfer as a timely and justified choice for salvaging failed reconstructive surgery for head and neck cancer.

並列關鍵字

pectoralis major myocutaneous flap ； salvage reconstruction ； head and neck cancer