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目的探讨下斜方肌皮瓣的解剖基础和该皮瓣在头颈部肿瘤切除术后大型组织缺损修复重建中的作用。方法回顾性分析中山大学附属第二医院颅颌面外科2000年1月—2004年1月间应用下斜方肌皮瓣对头颈部恶性肿瘤根治性切除后的缺损进行同期修复患者24例,男14例,女10例;年龄35～76岁,中位年龄54岁。其中舌癌10例,颊癌4例,口底癌2例,腮腺癌1例,口咽癌2例,牙龈癌3例,上颌窦癌1例,右颧、额部恶性肿瘤1例;15例为初发恶性肿瘤,9例为复发恶性肿瘤;皮瓣最小为8 cm×7 cm,最大为12 cm×10 cm。结果21例患者术后皮瓣全部存活,3例皮瓣远端部分坏死,供区I期愈合。术后随访6～24个月,全部皮瓣无坏死,头颈部形态功能满意。结论下斜方肌皮瓣具有血管蒂长、旋转度大,皮瓣薄而柔软,操作简便,适合同期修复头颈部术后较大的缺损。
Objective To investigate the anatomic basis of the lower trapezius myocutaneous flap and its role in the repair and reconstruction of large tissue defects after head and neck tumor resection. Methods A retrospective analysis of craniofacial surgery in the Second Affiliated Hospital of Sun Yat-sen University from January 2000 -2004 in January between the application of the lower trapezius myocutaneous flap on radical resection of head and neck cancer patients after resection of the defect in patients with 24 patients, male 14 cases, 10 females; aged 35 to 76 years, with a median age of 54 years. There were 10 cases of tongue cancer, 4 cases of buccal cancer, 2 cases of mouth cancer, 1 case of parotid gland carcinoma, 2 cases of oropharyngeal carcinoma, 3 cases of gingival carcinoma, 1 case of maxillary sinus cancer, 1 case of right zygoma and frontal malignant tumor. The cases were newly diagnosed malignant tumors and 9 were recurrent malignant tumors. The minimum flap size was 8 cm × 7 cm and the maximum was 12 cm × 10 cm. Results All the skin flaps survived in 21 patients, and the distal part of the flap was necrotic in 3 cases. All the patients were followed up for 6-24 months. All the flaps were free of necrosis and the function of head and neck was satisfactory. Conclusions Lower trapezius myocutaneous flap has the advantages of long vessel length, large rotation, thin and soft flap, easy operation and suitable for the repair of larger defects of head and neck postoperatively.