This article introduced a new method to repairthe mandibular micrognathia of mandible. Thehalf-split clavicle bone with bilateralsternocleidomastoid muscular pediclcs was used.Based on the results of our clinical data, it hadthe advantages of bone graft with vascularpodicle, no functional ill- effect in the donorsite, shortens the operative time, and might beaccomplished reliability in a one stage.
【Abstract】 Objective To investigate the effectiveness of pedicled sternocleidomastoid muscle flap in repairing defect after parotidectomy by comparing with direct suture. Methods The clinical data were retrospectively analyzed, which were from 73 patients with parotid tumor undergoing parotidectomy between January 2002 and April 2010. After parotidectomy, defects were repaired with pedicled sternocleidomastoid muscle flap in 38 cases (flap group) and with direct suture in 35 cases (control group). There was no significant difference in gender, age, disease duration, tumor location and size between 2 groups (P gt; 0.05). Meanwhile the complications, such as local introcession deformity, Frey’s syndrome and parotid gland fistula were observed. Results In flap group, the flaps were all alive and incisions healed by first intention; in control group, all incisions healed by first intention. All patients were followed up 6-98 months and no tumor recurred. There was significant difference in local introcession deformity between 2 groups (χ2=53.202, P=0.000). The parotid gland fistula was found in 1 case (2.6%) of the flap group and in 8 cases (22.8%) of the control group, Frey’s syndrome was found 1 case (2.6%) of the flap group and in 20 cases (57.1%) of the control group, showing significant differences between 2 groups (P lt; 0.05). Conclusion The use of pedicled sternocleidomastoid muscle flap for defect repair after parotidectomy can avoid the complications of local introcession deformity, Frey’s syndrome, and parotid gland fistula.
our patients with brachial plexus root arulsion, who had undergone various nerve operationswith no functional recovery of the limb, were treated with transfer of sternocledomastoid muscle toreconstruct the function of elbow fleaion. The sternocleidomastoid muscle was datached from itsincertions and was lengthened by fascia lata graft from the thigh , and then , was transferred under theclavicle to the radiai shaft just distal to the radial tuberosity. After the recostruction, The potient...
Objective To investigate cl inical effect and prognosis of the modified sternocleidomastoid (MSCM) myocutaneous flap for reconstruction of tissue defects in patients with oral carcinomas undergoing tumorectomy. Methods From April 2001 to January 2007, 43 patients with large or medium-sized tissue defects because of oral carcinomas radical operation were treated with MSCM myocutaneous flap. There were 31 males and 12 females with an average age of 58.5 years(25-76 years). The disease course was 25 days to 14 months (4.5 months on average). There were 27 cases of well-differentiated squamous cell carcinoma (SC), 14 cases of poorly-differentiated SC, 1 case of rhabdomyosarcoma, and 1 case of adenoid cystic carcinoma. Affected locations were tongue in 25 cases, mouth floor in 11 cases, lower gingiva in 4 cases, and buccal mucous membranes in 3 cases. According to 2002 International Union Control Cancer criterion for cl inical stage, there were 3 cases of stage I, 13 cases of stage II, 7 cases of stage III, and 20 cases of stage IV. Both the ranges of soft tissue defects and the flap were from 4 cm × 3 cm to 8 cm × 6 cm. The vital ity of the flaps and the heal ing of wounds were observed postoperatively. The function restoration of deglutition and dehisce were observed during the follow-up period. Results Necrosis of quarter MSCM myocutaneous flap occurred in 3 cases 1 week after operation, wounds healed by secondary intention after dressing; other flaps were survival. Infection with fluidify occurred at the donor site of 2 cases, wounds healed by incision and drainage; other incision at the donor sites healed primarily. No arterial or venous crisis occurred in all 43 flaps after 48 hours of operation. Thirty-nine patients were followed up for 6 months to 6 years. The 3 patients with buccal carcinoma could open their mouths normally. The function of deglutition and pronunciation were recovered in 24 patients with tongue carcinoma. Only 3 patients needed to have soft diet after operation. In 26 patients who were followed up above 2 years, oral metaplasia of the the skin flaps epithel ium was observed. Four patients and 2 patients recurred and died after 6 months and 1 year of operation, respectively.Two patients received the second operation after 6 months because of the metastatic lymph node, and survived up to now. The 2-year survival rate was 85%. Conclusion MSCM myocutaneous flap is simple to perform and effective in reconstruction of tissue defects for patients with oral carcinomas. It has active effect to recover the function of oral and axillofacial region and elevate l iving qual ity of patients.
OBJECTIVE To explore a new surgical approach to repair facial paralysis in late stage, using regional transposition of pedicled sternocleidomastoid muscle for the dynamic reanimation of the paralyzed face. METHODS Seven cases with facial paralysis in late stage from December 1999 were treated and followed up for 10 months before clinical evaluation. In all of the cases, the sternal and clavicular branches of the sternocleidomastoid muscle were both elevated from their bony attachments, with the mastoid insertion left in situ as the pedicle for blood supply and accessory nerve maintained in it. The muscle strips were transposed and sutured to the orbicularis oris around the mouth corner on the paralyzed side. RESULTS Static asymmetry of nose and oral commissure on the paralyzed side were corrected immediately after operation, and the movement of the oral commissure recovered one week after operation. Symmetric smiling was observed in one month and all of the oral movements recovered in 10 months postoperatively. CONCLUSION The new approach to repair facial paralysis in late stage by regional transposition of pedicled sternocleidomastoid muscle is effective in restoration of both static and dynamic symmetry of nose and mouth, and in recovery of the facial expression and the oral commissure.
目的探讨经胸锁乳突肌前缘入路行甲状腺良性肿瘤切除术的体会。方法2002年10月至2010年10月期间我院对128例甲状腺良性肿瘤患者行经胸锁乳突肌前缘入路甲状腺手术，手术切口采取皮内缝合。结果所有患者均顺利完成手术。手术时间45~130 min（平均65 min），术中出血10~100 ml（平均40 ml）； 引流管均在术后第2天拔除，引流量15~30 ml（平均20 ml）； 手术切口长3~7 cm（平均5 cm），均一期愈合； 住院时间3~6 d（平均4.5 d）。术后无出血，无神经、甲状旁腺损伤及其他并发症。术后随访0.5~8年（平均5.5年），12例患者（9%）复发，复发时间为术后1~3年（平均1.5年）; 8例患者结节lt;1 cm，给予临床观察; 其余4例患者经相同入路经二次手术治愈，随访无复发，未发现甲状腺癌。结论经胸锁乳突肌前缘入路行甲状腺良性肿瘤切除术不损伤或横断舌骨下肌群，术中出血少，无颈部肌肉瘢痕粘连影响外观之虑。
Objective To study the methods and results of a combination of forehead skin flap and sternocleidomastoid island myocutaneous flap in the reconstruction of large through-andthrough defect of check. Methods One case of check cancer received ampliative resection and functional neck dissection. The defect area of the skin side was 9 cm×7 cm, of the mucosa side 4.5 cm×3.0 cm.The defect of the mucosa side was repaired with sternocleidomastoid island myocutaneous flap which blood supply was from thyroidea superior artery, occipitalis artery and carotis extera vein; of the skin side with forehead skin flap which blood supply was from temporalis superficialis artery and vein. The size of the sternocleidomastoid island myocutaneous flap was 5 cm×3 cm, of the forehead skin flap10 cm×6 cm. Results Two flaps and the split survived after operation. One-stage healing was achieved. The patient was discharged from hospital 2 weeks afteroperation.The color and the quality were good.The tumor did not recur during follow-up of one year. The patient could take care of herself, and she lived normally in talk and diet. Conclusion A combination of forehead skinflap and sternocleidomastoid island myocutaneous flap is a useful method to repair large through-and-through defect of cheek after cancer dissection. It is easy-to-operate and economical.