Analysis The Causes Of Pectoralis Major Myocutaneous Flap Necrosis And Experience Of Prevention Treatment

Backgroud: The position and the anatomy of head and neck is complex,so the head and neck cancer patients after tumor excision surgery often get larger defect of local tissue which will do serious impact to original physiological function and local appearance. For head and neck surgery of large-area soft tissue defects, pectoralis major myocutaneous flap has a fixed anatomic location, easy preparation process, the postoperative survival rate is high, the organization is especially abundant, anti-infection ability and other characteristics, so more applied in the reconstruction of the soft tissue defect and repair. But since its application in clinical infections for the area and the area after, pharyngeal fistula, myocutaneous flap necrosis and donor site complications such as hematoma were reported, although scholars at home and abroad have already done a lot of studies to the related factors of production, but there is still no criterion of prevention measures.Objective: To explore the cause of the pectoralis major myocutaneous flap necrosis and the effective method of prevention and treatment.Methods: From November 2008 to November 2013,do retrospective analysis of the clinical data of 117 cases of pectoralis major myocutaneous flap transfer cases the institute. Including 12 cases of tonsil carcinoma, 55 cases of stomach carcinoma, 34 cases of recurrent laryngeal carcinoma, 16 cases of pharyngeal fistula. The pathological type of all the patients with tumor is squamous cell carcinoma. Tumor TNM staging: Ⅱ period in 16 cases, Ⅲ period in 65 cases, 20 cases Ⅳ period. If patients preoperatively combined basic diseases, especially diabetes, hypoalbuminemia and high blood pressure, the related indicators had already adjusted to normal before the surgery. All patients preoperatively or postoperatively all had done tracheal fistula or tracheotomy.Results: In 117 cases of pectoralis major myocutaneous flap, 13 cases got necrosis, which all necrosis occurs in 2 cases, 11 cases got partial necrosis. in the process of preparation of 117 cases of pectoralis major myocutaneous flap which had found that 3 cases of vascular control is given priority to the lateral thoracic artery, the remaining 114 are chest shoulder peak artery. In 3 cases which given priority to the lateral thoracic artery blood vessels that dominate the pectoralis major myocutaneous flap, only one case that the lateral thoracic artery injury happened all necrosis,Ⅱperiod in pectoralis major myocutaneous flap to repair the contralateral succeed. in 114 cases with thoracic acromion artery dominance of pectoralis major myocutaneous flap,only one surgery operation was mortally wounded in the chest shoulder peak artery, in the same period with the contralateral pectoralis major myocutaneous flap to repair. Of 11 cases of partial necrosis, 7 cases with diabetes mellitus, 2 cases of obese patients, 2 cases of large doses of radiation. 3 cases for subcutaneous hemorrhage effusion, be removed after healing. 11 cases of partial necrosis adopt treatment processing, respectively gotⅡhealing after 3 ~ 7 weeks. Of 7 cases of infection in repair area, there are pharyngeal fistula in 3 cases with partial pectoralis major myocutaneous flap necrosis, Pharyngeal fistulaⅡhealing after dressing, the rest 4 cases, 2 cases after active treatment transform from larger pharyngeal fistula to small pharyngeal fistula, the other 2 cases of pharyngeal fistula is not shrinking; 4 cases of pharyngeal fistula, 3 cases by local skin flap in the repair, 1 case of using local bridge flap, all healed well.Conclusion: Pectoralis major myocutaneous flap necrosis is mainly with the patient’s general condition, flap blood supply vessels dominate, to repair the defect area and skills related to multiple factors. effective processing of basic diseases Preoperatively, fully understanding of the intraoperative blood supply of pectoralis major myocutaneous flap preparation techniques, and skilled in pectoralis major myocutaneous flap are important measure to reduce the number of pectoralis major myocutaneous flap necrosis.