[The application of double pedicle blood supply pectoralis major myocutaneous flap in reconstruction of laryngeal and hypo pharyngeal defect after carcinoma resection].

OBJECTIVE: To explore the application of double pedicle blood supply pectoralis major myocutaneous flap in reconstruction of laryngeal and hypo pharyngeal defect after carcinoma resection.

METHOD: All the patients received initial treatment. Pectoralis major myocutaneous flap was Applied in one-stage reconstruction in 22 cases of laryngocarcinoma and hypopharyngeal carcinoma with post-operation defect. During operation, pectoral branches of thoracoacromial vessels and branch of lateral thoracic vessels were reserved and prepared to be double pedicle vessel fascia bundle without muscle at the beginning part, rearched to defect area through subclavian tunnel. After operation, it is necessary to closely observe the subcutaneous swelling, quantity and color of the drain and others of neck surgery area to exclude the occurrence of surgical hematoma. When there is suspicion, do timely exploration.

RESULT: Pectoralis major myocutaneous flaps of 22 patients were all survived. Pharyngeal fistula occurred in 2 cases and was cured by change of dressing. Twenty-one cases received radiotherapy after operation without secondary flap necrosis. After follow-up of 6 months to 24 months, one case of roll repairment of circumferential defect in cervical esophagus,found to have anastomotic stenosis 8 months after radiotherapy and then underwent gastrostomy treatment,the other 21 cases showed good recovery of swallowing function. Among 13 cases with laryngeal function reserved, only 1 case wearing tube and the extubation rate was 92.3% without communication barriers, no patient died in the short follow-up period.

CONCLUSION: For double pedicle blood supply pectoralis major nyocutaneous flap, blood supply are fully guaranteed and does not require complicated equipment to observe and monitor the flap blood supply after operation, it is important to exclude factors that may lead to muscular flap necrosis to ensure the survival of pectoralis major myocutaneous flap.