The pectoralis major myocutaneous flap was used to repair laryngopharyngeal and esophageal defect following radical excision of pharyngeal and inferior laryngeal carcinomas in 3 cases. The results were susscessful. The patients were follwedup for 6 months to 3 years. The deglutition functions were all reestablished, the general nutritional conditions were improved, and no recurrence or distant metastasis was observed. The advantages of this operative procedure were discussed.
目的通过改良Robicsek法胸骨固定及双侧胸大肌内侧头转移在非体外循环冠状动脉旁路移植术（OPCAB）患者胸骨固定中的应用，探讨此技术在预防OPCAB术后胸骨并发症的作用。 方法回顾性分析2011年2月至2013年4月北京安贞医院46例符合高危人群指征的心脏病患者行改良Robicsek法胸骨固定及双侧胸大肌内侧头转移手术的临床资料。男17例，女29例；年龄63～82（68.6±4.6）岁。 结果46例患者手术过程顺利，无1例发生胸骨并发症。1例死于围手术期心肌梗死、左心力衰竭，其余患者术后肌瓣存活良好。45例术后14 d拆线，伤口愈合良好。所有患者出院后1个月、6个月进行随访，皮肤切口愈合良好，胸骨固定良好，无窦道形成，未见反常呼吸运动，胸廓外形良好。 结论相对于传统闭合切口的方法，对可能发生胸骨合并症的高危人群，采用改良Robicsek法胸骨固定及双侧胸大肌内侧头转移术有一定的优势，能降低胸骨裂开及切口感染的概率，从而降低全身感染的概率，缩短患者康复时间，减轻心理压力。
OBJECTIVE: To evaluate the clinical application of primary transfer of pectoralis major to reconstruct the elbow flexion and shoulder abduction. METHODS: 12 cases of old injury of branchial plexus with dysfunction of both elbow and shoulder joints were received surgical operation to reconstruct the palsy joints by primary transfer of pectoralis major, shoulder abduction was reconstructed by clavicular head and elbow flexion by sternal head respectively. All cases were followed up for 5 to 18 months. RESULTS: The function of both joints recovered obviously, the total superior rate is 91.7%. CONCLUSION: Only if the palsy joints, shoulder or elbow, remained normal or almost normal passive motion, and the muscle power of pectoralis major over 4 degrees, the primary transfer of pectoralis major should be a simple, reliable and convenient technique to reconstruct the palsy joints.
Objective To investigate the clinical effect ofthe pectoralis major myocutaneous flap and Ti-plate system in repairing mandibular defects caused by resection of oral carcinoma.Methods From November 2001 to February 2003, 32patients with mandibular defect caused by resection of oral carcinoma were treated. Combined radical neck dissection with resection of gingival and mandible was performed on 11 patients with carcinoma of the lower gingival, combined radical neck dissection with glossectomy and mandibulectory on 13 patients with carcinoma of tongue, combined radical neck dissection with resection of floor of mouthand mandible on 4 patients with carcinoma of floor of mouth, and combined radical neck dissection with resection of cheek and mandible on 4 patients with carcinoma of buccal mucosa, respectively. The defects of mandible were associated with soft-tissue component, the sizes of defect ranged from 5.5 cm×7.6 cm to 8.2 cm×10.5 cm. The defects were reconstructed with 6 cm×7 cm to 9 cm×10 cm pectoralis major myocutaneous flaps and Tiplate system. The effect was studied retrospectively. Results Thirty-two cases were followed for 219 months; 29 cases offlaps survived and 3 cases of flaps partly necrosed (10% or less of the skin paddle). The appearance of face was satisfactory in 27 patients, and slight deformity of face was observed in 5 patients. The occluding relation and masticatory function were recovered well. Opening mouth extents ranged from 2.7 cm to 3.4 cm. No temporomandibular arthrosis relating to operation was found in all cases. Conclusion A combination of thhe pectoralis major myocut aneous flap and Ti-plate system is an ideal method for reconstruction of mandible defects associated with soft-tissue component after radical operation of oral carcinoma.
ObjectiveTo investigate the feasibility of the bipaddled split pectoralis major myocutaneous flap for immediate reconstruction of oral mucosal defects and neck defects after resection of recurrent oral cancer. MethodsSix patients with oral mucosal defects combined with neck defects after recurrent oral cancer resection were treated with bipaddled split pectoralis major myocutaneous flap between September 2013 and September 2014. There were 5 males and 1 female with an average age of 54.7 years (range, 45-62 years), including 4 cases of recurrent tongue cancer, 1 case of recurrent mandibular gingival cancer, and 1 case of mouth floor carcinoma. All patients underwent local recurrence at 8 to 14 months after first operation, with no distant metastasis. The defects of the intraoral mucosa was 4.0 cm×2.5 cm to 6.5 cm×3.5 cm and the defect of the neck skin was 5.5 cm×3.5 cm to 7.5 cm×5.0 cm. The pectoralis major myocutaneous flaps (14.0 cm×3.5 cm to 17.0 cm×5.5 cm) were incised at the level of the 3rd to the 4th rib, and then split down along the muscle fiber till about 2 cm away from the thoracoacromial vessels, forming 2 independent skin paddles with 1-2 branch vessels to the pedicles of the distal ones. The distal skin paddles were used for oral reconstruction while the proximal paddles for repair of neck defects. The chest donor sites were sutured directly. ResultsCervical haematoma and infection happened in 1 patient respectively after operation, and were cured after symptomatic treatment. All 6 split pectoralis major myocutaneous flaps with 12 skin paddles completely survived. All patients were followed up 6 to 18 months (mean, 11 months). One patient died of pulmonary metastasis at 8 months after operation and the other 5 survived without relapse or metastasis during follow-up. The intraoral paddles showed good shape with satisfactory speech function and swallowing recovery. The paddles also healed perfectly on the neck with flat outlooks, and all patients obtained full appearance and free movement of the neck. No fistula formed on the submandibular region and neck. ConclusionThe bipaddled split pectoralis major myocutaneous flap can complete simultaneous immediate reconstruction of oral mucosal defect and neck defect. It is very useful in the treatment of recurrent oral cancer.
Twohundrednineteen orofaciomaxillary tumours, 18 benigns and 201 malignancies, were repaired by pectoralis major myocutaneous flaps following their resections. The types of flaps used in the repair were: single island myocutaneous flaps in 201 cases, doubleisland myocutaneous flaps in 16 cases, and myocutan eous skeletal flaps in 2 cases. The results were susscessful in 201 cases and failure in 18. The advantages and indications of using pectoralis major myocutaneous flaps were discussed. The method of design and its relevent surgical thechniques were introduced, and the factors responsible for the success and failure were analyzed. It is noted that the correct and meticulous operative techniques were the main factors leading to operative success.
Objective To explore the effectiveness of pedicled chimeric thoracoacromial artery perforator (TAAP) flap as a reconstructive option for circular hypopharyngeal defects. Methods Between January 2013 and December 2014, the pedicled chimeric TAAP flap was used to repair oncologic circular hypopharyngeal defects in 8 patients, included 6 males and 2 females, with an average age of 57 years (range, 45-80 years). All patients were treated in other hospitals before and recurrence was noted. The duration between latest treatment and recurrence ranged from 3 to 28 months (mean, 16.5 months). According to Union for International Cancer Control (UICC) TNM staged, 3 cases were T2N1M0, 2 cases were T3N1M0, 1 case was T3N2M0, 2 cases were T4N1M0. After laryngectomy, the size of circular hypopharyngeal defect ranged from 9.0 cm×8.5 cm to 12.0 cm×10.5 cm. The size of TAAP flap ranged from 7.0 cm×4.0 cm to 9.5 cm×6.0 cm．The size of pectoralis major flap ranged from 9.0 cm×5.0 cm to 14.5 cm×6.0 cm．The donor sites were closed directly in all cases. Results Postoperatively all flaps survived smoothly, and all defects healed by first intention. No early complication was noted. The mean hospital stay period ranged from 12 to 22 days (mean, 14.5 days). All patients were followed up 12-45 months (mean, 18.7 months). Patients possessed good appearance of surgical sites. No recurrence, fistulas, stenosis/strictures, dehiscence, or swelling occurred. Only linear scars were left on the donor sites, and the pectoralis major muscle function was completely preserved in all patients. Conclusion Patients with high comorbidities may not be suitable candidates for free flap reconstruction, especially when the recipient vessels are affected from disease or radiotherapy. Pedicled chimeric TAAP flap is a good choice for the reconstruction of hypopharyngeal defects in such conditions．
ObjectiveTo explore the method of implant coverage with local soft tissue in immediate implant-based breast reconstruction and to evaluate the early effectiveness. MethodsBetween April 2014 and August 2015, 11 patients with breast cancer underwent immediate breast reconstruction with implants after mastectomy, and the clinical data were reviewed retrospectively. The age ranged 29-48 years (mean, 36 years). The disease duration was from 7 days to 12 months (median, 3 months). According to tumor staging, 3 cases were rated as TisN0M0, 4 cases as T1N0M0, and 4 cases as T2N0M0. The implants were covered with local soft tissue according to the volume of mastectomy and contralateral breast size, including pectoralis major myocutaneous flaps with inframammary adipofasical flaps (3 cases), with serratus anterior fascial flap (5 cases), with rectus sheath fascial flap (1 case), and with serratus anterior fascial flap and rectus sheath fascial flap (2 cases). The size of pectoralis major myocutaneous flaps ranged from 15 cm×9 cm to 20 cm×15 cm, and the serratus anterior fascial flaps from 10 cm×8 cm to 15 cm×10 cm, and the rectus sheath fascial flap from 8 cm×6 cm to 10 cm×8 cm. ResultsOne patient had partial nipple necrosis postoperatively and was cured, and no other postoperative complications of hematoma, infection, or implant exposure was found. The patients were followed up 4-13 months (median, 8 months). The reconstructive outcomes were excellent in 10 cases and good in 1 case, with an excellent and good rate of 100%. During follow-up, no rupture or exposure of the implant was observed; capsular contracture (Baker grade II) occurred in 1 case. ConclusionAdequate coverage of implants with different local soft tissue flaps can achieve satisfactory early effectiveness in immediate implant-based breast reconstruction after mastectomy.