[Clinical effects of flaps with cervical cutaneous branch of transverse cervical artery in repairing neck radiation ulcers]

Abstract

Objective: To explore the clinical effects of flaps with cervical cutaneous branch of transverse cervical artery in repairing neck radiation ulcer. Methods: The retrospective observational research was conducted. From January 2016 to December 2019, 8 cases with neck radiation ulcer were admitted to Guangzhou Red Cross Hospital of Jinan University and repaired with flaps based on cervical cutaneous branch of transverse cervical artery. There were 6 males and 2 females, aged 52-75 years. The ulcers occurred 14.5 years after radiotherapy on average, with ulcer areas of 5.0 cm×3.0 cm-7.0 cm×6.0 cm on admission. The wound areas were ranged from 6.0 cm×5.0 cm to 13.0 cm×6.5 cm after ulcers and fibrotic tissue around were resected. Seven cases underwent resection of flaps and wound repair operation on the first stage, and the other 1 case underwent pre-expansion of flap donor area on the first stage and resection of flap and wound repair operation on the second stage, with flap sizes of 8.0 cm×7.0 cm-15.0 cm×8.5 cm. The wounds in the donor areas of flaps in 7 patients were sutured directly, and the wound in the donor area of flap in the other 1 patient was repaired with thin split-thickness skin graft from thigh after being sutured partially. The preoperative ulcer tissue was collected for pathological examination, and the postoperative survival of the flaps and healing of the flap donor areas were observed. The flaps, the recurrence of the neck ulcers and neck function, and the scar hyperplasia in the donor areas of flaps were observed during follow-up. Results: Preoperative pathological examination of ulcer tissue showed that full-thickness necrosis occurred in ulcer skin, obvious fibrotic tissue hyperplasia, collagenization, and small-scale calcification in the base and surrounding tissue of the ulcers, and a large amount of chronic inflammatory cells and a small amount of acute inflammatory cells infiltration were observed in intercellular substance, which excluded the recurrence of tumor. All the flaps in 8 cases survived, the wounds were repaired effectively, and the postoperative donor areas of flaps healed well. During postoperative follow-up of 6-24 months, the flaps had good appearances without recurrence of ulcer, the movement function of neck was significantly improved, and no obvious scar hyperplasia was observed in the donor areas of flaps. Conclusions: Radiation ulcer in the neck is a serious long-term complication of neck after radiotherapy, which is difficult to heal with conservative treatment. The flap with cervical cutaneous branch of transverse cervical artery is close to the neck, with rich blood supply, constant anatomy, and is easy to cut. Neck radiation ulcers treated with the flaps showed good wound healing and improved functions, with no obvious scar hyperplasia.

图 1

左侧颈横动脉颈段皮支皮瓣修复例1鼻咽癌患者颈部淋巴结放射治疗12年后左侧颈部放射性溃疡。1A.术前溃疡周围皮肤变硬, 面部明显水肿, 颈部活动受限；1B.术前溃疡组织病理学检查提示全层皮肤坏死, 溃疡周围严重纤维化, 伴较多淋巴细胞浸润苏木精-伊红×100；1C.术前磁共振血管成像提示患者颈横动脉颈段皮支存在, 充盈良好；1D.术中切除溃疡及周围纤维化组织并设计皮瓣；1E.切取皮瓣；1F.皮瓣分离到颈横动脉颈段皮支穿出点；1G.皮瓣与创面边缘间断缝合, 皮瓣供区减张缝合缩小后用自体大腿薄中厚皮片修复；1H.术后1年颈部活动度得到改善, 溃疡无复发, 皮瓣供区未见明显瘢痕增生

图 2

左侧颈横动脉颈段皮支皮瓣修复例2鼻咽癌患者颈部淋巴结放射治疗10年后左侧颈部放射性溃疡。2A.术前溃疡较多渗出, 周围组织质硬；2B.术前溃疡组织病理学检查提示全层皮肤坏死, 微脓肿形成及炎性肉芽增生, 周围广泛纤维化苏木精-伊红×100；2C.术前磁共振血管成像提示颈横动脉颈段皮支存在, 充盈良好；2D.术中切除溃疡及周围纤维化组织及皮瓣设计；2E.术中皮瓣切取；2F.皮瓣分离到锁骨上2 cm, 颈横动脉颈段皮支穿出点；2G.皮瓣与创面边缘间断缝合, 皮瓣供区真皮层远位减张缝合；2H.术后1年颈部活动障碍改善, 溃疡无复发, 皮瓣供区瘢痕增生不明显