摘要目的 介绍改良带蒂胸肩峰动脉穿支(thoracoacromial artery perforator,TAAP)皮瓣用于复杂咽瘘缺损修复的临床经验.方法 回顾性分析2011年12月至2015年9月,湖南省肿瘤医院应用改良带蒂TAAP皮瓣修复重建的9例复杂咽瘘缺损.患者均为男性,年龄28 ～ 72岁,咽瘘缺损面积范围自4.5 cm×2.5 cm至6.5 cm ×4.5 cm,TAAP皮瓣皮岛大小自7.0 cm ×4.0 cm至8.0 cm×5.0 cm;颈部皮肤软组织瘘口缺损大小自4.0 cm ×3.0 cm至6.0 cm ×4.0 cm,TAAP皮瓣皮岛大小自5.5 cm×3.5 cm至7.0 cm×5.0 cm.结果 9例皮瓣术后全部顺利成活,所有供区直接闭合,未见皮瓣血管危象和皮瓣坏死情况发生.患者的平均住院时间为10.4d.术后钡餐造影显示下咽通畅,无狭窄和咽瘘复发.随访8～ 32个月,所有患者颈部外形良好,均恢复经口进食.皮瓣供区仅遗留线性瘢痕,胸大肌功能无损伤.结论 改良带蒂TAAP皮瓣适用于修复复杂咽瘘缺损合并颈前区皮肤软组织缺损.

abstractsObjective To report our experience in the application of modified pedicled thoracoacromial artery perforator (TAAP) flap for the repair of complex pharyngocutaneous fistula.Methods Between December 2011 and September 2015,modified pedicled TAAP flaps were used to repair pharyngocutaneous fistulas in 9 patients.All patients were males,and ranged in age from 28 to 72 years old.Fistula size ranged from 4.5 cm × 2.5 cm to 6.5 cm × 4.5 cm,and the TAAP skin paddle size ranged from 7.0 cm × 4.0 cm to 8.0 cm × 5.0 cm.Neck defect size ranged from 4.0 cm × 3.0 cm to 6.0 cm × 4.0 cm,and the TAAP skin paddle size ranged from 5.5 cm × 3.5 cm to 7.0 cm × 5.0 cm.Results All 9 flaps survived smoothly and all the donor sites were closed directly,with no flap vascular crisis and necrosis.The mean hospitalization of patients was 10.4 days.Postoperative barium swallow showed no hypopharyngeal stenosis or fistula recurrence.The follow-up time ranged from 8 to 32 months.The appearance of neck was good and all patients accepted oral diet.Only linear scar was left on the donor site,with no significant impairment of the function of pectoralis major muscle.Conclusion Modified pedicled TAAP flap is suitable for the repair of complex pharyngocutaneous fistula.