Clinical analysis of diversity of defect repair with supraclavicular island flap after head and neck tumor surgery
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摘要: 目的 探讨锁骨上岛状皮瓣修复头颈部肿瘤术后缺损的多样性和临床疗效。方法 回顾性分析2017年1月—2023年3月重庆医科大学附属第一医院耳鼻喉科收治的30例头颈肿瘤术后接受锁骨上岛状皮瓣修复缺损患者的临床资料，记录缺损部位、缺损类型、术中出血量、皮瓣制取时间、皮瓣面积、存活情况以及术后并发症。结果 入组30例患者，其中男26例，女4例，年龄36~82岁。修复下咽部分缺损22例(同侧19例，对侧3例)，联合对侧胸大肌皮瓣修复下咽环周缺损2例，修复颈部皮肤缺损2例，腮腺区皮肤缺损2例，颞骨区皮肤缺损1例，颈段食管缺损1例。皮瓣制取术中平均出血量8 mL，皮瓣制取平均32 min，皮瓣面积范围：5.0 cm×4.0 cm~20.0 cm×8.0 cm，30例皮瓣存活27例(90.0%)，6例并发术后咽瘘(经换药后皮瓣存活4例)；1例并发静脉血栓(经换药后皮瓣坏死)。29例患者肩颈部功能(抬举、内旋、外展)未受明显影响，1例并发肩部感染经治疗后功能未受影响。结论 锁骨上岛状皮瓣是一种高度血管化的轴形筋膜瓣，易于制取，质地薄而柔软，可用于修复不同部位和不同类型头颈肿瘤术后缺损，供体部位并发症率低。在头颈部肿瘤术后修复中效果良好，值得推广。Abstract: Objective To investigate the diversity and clinical effect of supraclavicular island flap in repairing the defect after head and neck tumor surgery.Methods A retrospective analysis was performed on 30 patients who received the repair of head and neck defects with supraclavicular island flaps at Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Chongqing Medical University from January 2017 to March 2023. The sites and types of defects, intraoperative blood loss, time of flaps preparation, areas of flaps, survival of the flaps and other complications were recorded.Results A total of 30 patients were enrolled, including 26 males and 4 females, aged 36-82 years. Among them, 22 patients with hypopharyngeal partial defect were repaired (19 patients with ipsilateral defect and 3 patients with contralateral defect). In addition, 2 patients were repaired with contralateral pectoralis major musculocutaneous flap around the hypopharynx, the neck skin defect was repaired in 2 patients, the parotid skin defect was repaired in 2 patients, the temporal bone skin defect was repaired in 1 patient, and the cervical esophageal defect was repaired in 1 patient. The average blood loss during the operation was 8 ml, and the average time was 32 min. The flap areas ranged from 5.0 cm×4.0 cm to 20.0 cm×8.0 cm. 27 of 30 flaps survived(90.0%), and pharyngeal fistula occurred in 6 patients after operation(4 flaps survived after local dressing). One patient was complicated with venous thrombosis(the flap necrosis after local dressing). Shoulder and neck functions(lift, internal rotation and abduction) were not significantly affected in 29 patients, and the function of 1 patient with shoulder infection was not affected after treatment.Conclusion Supraclavicular island flap is a highly vascularized axial fascial flap. It is easy to make, thin, and soft in texture, and can be used to repair different sites and types of postoperative head and neck tumor defects with a low donor site complication rate. Good results in post-operative repair of head and neck tumors are worth promoting.
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Key words:
- supraclavicular island flap /
- head-neck tumors /
- postoperative defect /
- repair
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表 1 30例患者皮瓣相关信息
序号 年龄
/岁性别 TNM分期 诊断 手术方式 同对侧 重建部位 皮瓣制取时间
/min术中皮瓣出血量
/mL皮瓣面积
/cm2术后并发症 1 60 男 T4aN1M0 下咽癌 全喉、部分下咽切除术 同侧 咽腔 18 5 8.0×6.0 咽瘘 2 58 女 无 颈部继发恶性肿瘤 右颈淋巴结清扫术 同侧 腮腺区 27 9 8.0×7.0 静脉
血栓3 55 男 T2N1M0 下咽癌 部分喉、部分下咽切除术 对侧 咽腔 17 10 7.0×5.0 无 4 61 男 T4aN2cM0 喉癌 全喉、部分下咽切除术 同侧 颈部皮肤 30 7 7.0×5.0 无 5 69 男 无 腮腺多形性腺瘤 右侧腮腺全切术 同侧 腮腺区 28 5 9.0×8.0 无 6 70 男 T4aN1M0 喉癌 全喉、部分下咽切除术 同侧 咽腔 32 4 8.0×7.0 无 7 66 男 T2N1M0 下咽癌 全喉、全下咽切除术 同侧 下咽环周 45 8 10.0×8.0 无 8 46 男 T3N2bM0 下咽癌 部分喉、部分下咽切除术 同侧 咽腔 34 7 7.0×6.0 无 9 56 男 T4aN3M0 下咽癌 全喉、部分下咽切除术 同侧 咽腔 19 4 6.0×5.0 咽瘘 10 69 男 T4N1M0 下咽癌 全喉、部分下咽切除术 对侧 咽腔 20 6 7.0×6.0 无 11 72 女 无 左侧外耳道腺样囊性癌 左侧颞骨次全切除术 同侧 颞骨区 42 10 12.0×10.0 无 12 54 男 T2N3M0 下咽癌 部分喉、部分下咽切除 同侧 咽腔 50 10 8.0×7.0 无 13 66 男 T3N0M0 下咽癌 全喉、部分下咽切除术 同侧 咽腔 30 7 8.0×6.0 无 14 63 男 T4aN0M0 下咽癌 全喉、部分下咽切除术 同侧 咽腔 27 7 8.0×6.0 无 15 65 男 T4aN2bM0 下咽癌 全喉、部分下咽切除术 同侧 咽腔 32 12 7.0×5.5 咽瘘 16 82 男 T3N1M0 下咽癌 全喉、部分下咽切除术 同侧 咽腔 29 8 8.0×6.0 无 17 72 男 T4aN0M0 下咽癌 全喉、部分下咽切除术 对侧 咽腔 28 7 7.0×6.0 无 18 53 男 T2N2cM0 下咽癌 部分下咽切除术 同侧 咽腔 36 9 10.0×8.0 无 19 58 男 T3N2cM0 下咽癌 全喉、部分下咽切除术 同侧 咽腔 40 12 7.0×6.0 咽瘘 20 56 男 T4aN0M0 下咽癌 全喉全下咽切除术 同侧 下咽环周 35 8 8.0×7.0 咽瘘 21 62 男 T3N0M0 下咽癌 部分下咽切除术 同侧 咽腔 28 7 10.0×8.0 肩部
感染22 36 男 T2N0M0 下咽癌 部分下咽切除术 同侧 咽腔 23 4 9.0×7.0 无 23 65 女 T4bN1bM0 甲状腺乳头状癌 全喉及颈前皮肤扩大切除术 同侧 颈部皮肤 36 11 20.0×8.0 无 24 61 男 T3N2bM0 下咽癌 部分喉、部分下咽切除 同侧 咽腔 21 6 5.0×4.0 无 25 65 男 T3N1M0 下咽癌 部分喉、部分下咽切除术 同侧 咽腔 37 10 10.0×8.0 无 26 61 男 T2N1M0 下咽癌 部分喉、部分下咽切除术 同侧 咽腔 34 6 11.0×7.0 无 27 62 男 T2N0M0 下咽癌 部分下咽切除术 同侧 咽腔 33 8 10.0×6.0 无 28 68 男 T2N3M0 下咽癌 部分喉、部分下咽切除术 同侧 咽腔 38 10 10.0×8.0 无 29 64 女 T4aN0M0 颈段食管癌 全喉全下咽颈段食管切除术 同侧 颈段食管 47 14 8.0×7.0 咽瘘 30 62 男 T1N0M0 颌下腺鳞状上皮癌 右颌下腺淋巴上皮癌灶扩大切除术 同侧 咽腔 44 13 12.0×7.0 无 
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表 2 6例咽瘘患者基本信息
顺序 年龄/岁 诊断 TNM分期 术前放化疗 术前白蛋白
/g/L术后最低白蛋白/g/L 拔除引流管时间/d 手术时间
/min皮瓣结局 1 60 下咽癌 T4aN1M0 无 43 34 术后6 d 315 存活 2 56 下咽癌 T4aN3M0 无 45 30 术后5 d 465 存活 3 65 下咽癌 T4aN2bM0 无 37 27 术后5 d 460 存活 4 58 下咽癌 T3N2cM0 无 50 31 术后6 d 519 存活 5 56 下咽癌 T4aN0M0 有 46 25 术后5 d 480 坏死 6 64 下咽癌 T4aN0M0 无 40 34 术后7 d 450 坏死
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