Repair of cervical postradiation ulcer following radical mastectomy with lower trapezius myocutaneous flap
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摘要: 目的 探讨以同侧下斜方肌肌皮瓣转移修复乳腺癌根治术后放射性治疗导致的颈部溃疡的疗效。 方法 2010年3月—2015年2月,笔者单位收治6例乳腺癌根治术后放射性治疗导致的颈部溃疡患者,创面均有不同程度的持续疼痛。清创前创面面积为6 cm×4 cm~10 cm×6 cm,清创后创面面积为8 cm×5 cm~16 cm×10 cm。创面彻底清创后采用同侧下斜方肌肌皮瓣转移修复,肌皮瓣面积为10 cm×7 cm~20 cm×13 cm。供瓣区直接拉拢缝合或取背部中厚皮修复。 结果 所有患者术后第2天起创面疼痛明显缓解。5例患者伤口愈合;1例患者肌皮瓣远端有直径约1 cm浅表皮肤坏死,经保守换药治愈。随访3~18个月,溃疡均无复发,肌皮瓣质地柔软、外观良好,供区愈合良好。 结论 在彻底清创基础上,以同侧下斜方肌肌皮瓣修复乳腺癌根治术后放射性治疗导致的颈部溃疡是可行的选择。Abstract: Objective To explore the clinical effects of ipsilateral lower trapezius myocutaneous flap for repairing cervical ulcer as a result of radiotherapy after radical mastectomy. Methods Six patients with cervical ulcers as a result of radiotherapy after radical mastectomy were hospitalized from March 2010 to February 2015, suffering from persistent pain in different degrees. The wound area ranged from 6 cm×4 cm to 10 cm×6 cm before debridement, 8 cm×5 cm to 16 cm×10 cm after debridement. Ipsilateral lower trapezius myocutaneous flap was used to repair the wound after thorough debridement, with the area ranging from 10 cm×7 cm to 20 cm×13 cm. The donor sites were sutured directly or covered with medium-thickness skin graft obtained from the back. Results Pain was obviously relieved in all the patients 2 days after surgery. The wounds in five patients were healed, while necrosis of superficial skin approximately 1 cm in diameter appeared at the distal end of one myocutaneous flap, and it healed after dressing change. During the follow-up period of 3 to 18 months, no recurrence of ulcer was found, the texture of the myocutaneous flaps was soft with good appearance, and the donor sites healed well. Conclusions On the basis of thorough debridement, it is feasible to repair the cervical ulcer as a result of radiotherapy after radical mastectomy with the ipsilateral lower trapezius myocutaneous flap.
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Key words:
- Surgical flaps /
- Breast neoplasms /
- Neck /
- Radiation injuries /
- Ulcer /
- Wound repair
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