Objective To introduce experiences in the application of island myocutaneous flap for refractory wound in cervicothoracic region. Methods From August 1994 to December 2004, 98 cases of refractory wound in cervicothoracic region were treated; there 42 males and 56 females, aging 2168 years.The course of disease was 3 hours to 13 months. The locations were anterior pectorial region(29 cases), cervical part (28 cases), nuchal region (18 cases), subaxillary and axillary region (15 cases), and thoracic wall (8 cases). The defect area ranged from 6 cm×4 cm to 20 cm×15 cm. According to location, peculiarity and etiological factor of wound, various island myocutaneous flaps were selected: 28 pectoralis major island myocutaneous flaps,34 latissimus dorsi island myocutaneous flaps, 19 trapizius island myocutaneousflaps and 17 rectus abdominis island myocutaneous flap. The sizes of the dissected flap ranged from 8 cm×6 cm to 35 cm×15 cm. Results Of 98 patients, the woundhealed by first intention and the flap survived completely in 92 and the flap necrosed partially in 6. The good function and cosmetic results were obtained without severe complication. Eightythree cases were followed up from 2 weeks to 5 years. The flap obtained satisfactory appearance, good function and cosmetic results. Conclusion Repairing refractory wound in cerviconuchal region may selectpectoralis major island myocutaneous flap, latissimus dorsi island myocutaneousflap, and trapizius island myocutaneous flap; repairing refractory wound on thoracic region may select latissimus dorsi island myocutaneous flap and rectus abdominis island myocutaneous flap. According to specific condition of wound, using suitable island myocutaneous flap for refractory wound in cervicothoracic region may obtain satisfactory functional and cosmetic results.
The experience of the treatment of 5 thoracic ulcers and 1 large and deep neck ulcer was reported. Vascularized latissimus dorsi and rectus abdominis myocutaneous flaps were used to treat the ulcers with one failure. No recurrence was foundduring the followup from one to five years. In the early stage of acute inflammatory necrosis, treatment was focused on debridement. In order to remove the necrotic tissue and provide good drainage, it was not appropriate to cover the wound immediately. In the chronic stage, the radiation ulcers with their adjacent tissues should be excised. Island myocutaneous flap and axial pattern skin flap were selected to repair the wound. If the wound was too large, two flaps may be combined to cover it. No matter what kind of flap was chosen, the donor site should be far away from the ulcer.