頭頸部領域における大胸筋皮弁の二，三の応用

Reconstruction of Head and Neck using PMMC Flap

Ｉ．はじめに

　大胸筋皮弁は生着の優秀性ならびに遠隔部の再建に有利な点から頭頸都領域で広く用いられている。われわれも男性の下咽頭・頸部食道再建に大胸筋全部を用いる方法^1）で満足すべぎ結果を得ている。遊離植皮大胸筋皮弁（skin-quiltedPMMC）^2,3）は女性の頸部食道再建に有用であるほかいくつかの用途が考えられる。一力本皮弁のbulkyな特徴は頭頸部の大きな組織欠損の修復にきわめて好都合である。

　今回はこれらの自験例を報告し，大胸筋皮弁の利用方法および使用に当たって注意すべぎ点を検討した。

We reported three cases of head and neck reconstruction using a pectoralis major myocu-taneous flap (PMMC flap).

A skin-grafted PMMC flap was cosmetically excellent in female patients, however, primary reconstruction of cervical esophagus produced a marked stricture of the sutured ends. A skin-quilted muscle flap was better suited for closing large fistulas of the irradiated cervical region.

The PMMC flap was convenient for obliterat-ing a large space produced after an extended resection of advanced parotid cancer. Unfortunate-ly, a local recurrence in our case resulted in a rapid metastasis to the acromion and axilla through the muscle flap.

Primary grafting of a PMMC flap behind the facial skin after resecting the orbit satisfied not only an early return to work in a patient with maxillay cancer, but also the inspection of the operated wound.