Cervical-thoracic flap for repair of maxillofacial defect

The cervical and thoracic flap is a large rotating flap that is pedicled in the midline. It is an ideal flap for repairing defects in the cheeks and parotid glands. The upper edge of the cervical thoracic flap is designed to be in the lower edge of the defect area, extending posteriorly to the hairline plane of the posterior region of the ear; the posterior margin is from the posterior margin of the ear, along the neck of the hairline and the leading edge of the trapezius 2cm, parallel to the leading edge of the trapezius muscle, behind the shoulder clavicle of the shoulder, along the lateral edge of the pectoralis major; the lower edge of the flap is located in the third intercostal space and parallel to the clavicle; the pedicle of the flap is located in the neck The midline area of the department and chest. The cervical thoracic flap is a rotating flap of adjacent tissue. Its pedicle is large, the survival rate of the flap is high, safe and reliable, and no flap delay is needed. The color, shape and cheek of the flap were harmonious, and the postoperative scar was not obvious. However, due to the wideness of the pedicle, the range of rotation is somewhat affected. Curing disease: Indication Cervical and thoracic flap repair for maxillofacial defects is suitable for scars on the cheeks, parotid glands or a large range of skin defects after tumor resection. Contraindications Incomplete tumor resection, or local obvious infection, or high-dose radiation therapy should be used as a relative contraindication. Preoperative preparation 1. Keep the skin in the defect area and neck and chest dry and clean. 2, neck and chest inflammation should be cured more than 2 weeks before surgery can be considered. 3. Measure the extent and size of the defect and design the location, extent, size and direction of rotation of the flap. Surgical procedure 1. According to the range and size of the defect area before operation, the location and extent of the neck and chest flap are designed and drawn. Intraoperative injection of 1:50000 to 1:800,000 epinephrine or 0.25% procaine was performed under the cervical thoracic flap to reduce bleeding during surgery. 2. The tumor was removed along the incision line, the edge of the defect area was trimmed, and the skin, subcutaneous tissue and platysma of the cervical thoracic flap were cut. Deep up the subcutaneous tissue or deep platysma (the chest is on the pectoralis sarcolemma) and lift the pedicle of the flap to the proximal midline of the neck. 3. Rotate the cervical thoracic flap to reach the repaired area and make a layered intermittent suture. The "cat's ear" appearing in the pedicle of the rotating flap is trimmed, and the donor site is sutured or free-transplanted. A vacuum drainage was placed under the flap. complication Necrosis occurred at the tip of the flap. The prevention method is to observe the change of the color of the top of the flap before suturing. If the pale and bun cannot be improved in a short time, it means that the blood supply to the top part is insufficient, and the skin should be removed in time, and then the base of the flap is freed, and the normal color of the skin is sutured upward. valve.