Thoma A, Khadaroo R, Grigenas O, Archibald S, Jackson S, Young J E, Veltri K
Department of Surgery, St. Joseph's Hospital and McMaster University, Hamilton, Ontario, Canada.
Plast Reconstr Surg. 1999 Aug;104(2):368-78; discussion 379-80. doi: 10.1097/00006534-199908000-00007.
One of the more difficult problems in reconstructive surgery of the head and neck is replacement of bone and soft tissue lost because of injury, osteomyelitis, or malignancy. The radial-forearm osteocutaneous flap is an accepted choice for oromandibular reconstruction. This study was undertaken to review one center's experience with 60 consecutive cases of oromandibular reconstruction with the radial-forearm osteocutaneous flap. Records of the 38 men and 22 women (mean age, 60 years; range, 26 to 86 years) were reviewed for tumor location, defect and bone length, flap failure rate, recipient- and donor-site complications, length of surgery, and hospital stay. Cancer resection was the reason for 97 percent of reconstructions; 33 percent of flaps were used to reconstruct a lateral defect of the mandible, 40 percent a lateral-central defect, and 27 percent a lateral-central-lateral defect. Mean skin flap size was 55 cm2 (range, 15 to 117 cm2) and mean bone length, 9.4 cm (range, 5 to 14 cm). The microvascular success rate was 98.3 percent. Complications included fracture of the donor radius (15 percent), nonunion of the mandible (5 percent), and hematoma (8.3 percent). These results are comparable to results reported in the literature with other radial forearm flaps. The free radial osteocutaneous flap is a safe and reliable choice for mandibular reconstruction. It offers sufficient bone to reconstruct large defects and can provide adequate pedicle length for vessel anastomosis to the contralateral side of the neck. The above attributes make the radial forearm osteocutaneous flap one of the "first line" flap choices for oromandibular reconstruction.
头颈重建手术中较为棘手的问题之一是因损伤、骨髓炎或恶性肿瘤导致的骨与软组织缺失的修复。桡骨前臂骨皮瓣是口腔颌面部重建的常用选择。本研究旨在回顾某中心连续60例采用桡骨前臂骨皮瓣进行口腔颌面部重建的经验。对38例男性和22例女性（平均年龄60岁，范围26至86岁）的记录进行了回顾，内容包括肿瘤位置、缺损及骨长度、皮瓣失败率、受区和供区并发症、手术时长及住院时间。97%的重建手术原因是癌症切除；33%的皮瓣用于重建下颌骨外侧缺损，40%用于重建外侧 - 中央缺损，27%用于重建外侧 - 中央 - 外侧缺损。皮瓣平均面积为55平方厘米（范围15至117平方厘米），骨平均长度为9.4厘米（范围5至14厘米）。微血管吻合成功率为98.3%。并发症包括供区桡骨骨折（15%）、下颌骨骨不连（5%）及血肿（8.3%）。这些结果与文献中报道的其他桡骨前臂皮瓣的结果相当。游离桡骨骨皮瓣是下颌骨重建的安全可靠选择。它能提供足够的骨量以重建大的缺损，并可为与颈部对侧血管吻合提供足够的蒂长度。上述特性使桡骨前臂骨皮瓣成为口腔颌面部重建的“一线”皮瓣选择之一。
