Wolff K-D, Hölzle F, Eufinger H
Department of Oral and Plastic Maxillofacial Surgery, Knappschaftskrankenhaus, Ruhr-University, Bochum, Germany.
Int J Oral Maxillofac Surg. 2003 Dec;32(6):614-8. doi: 10.1054/ijom.2002.0395.
According to the concept of a free flap carrier we transferred an osteocutaneous fibula graft after microanastomosis to a pedicled radial forearm flap for reconstruction of the lower face in a patient with a total occlusion of the left and a subtotal occlusion of the right common carotid artery. The fibula was osteotomized in three segments to form the new mandible, and the skin paddle was placed extraorally. An external fixation device was connected to the radial bone, and a halo frame was fixed to the skull, and the forearm was thus stabilized rigidly in a suitable position. After 2 weeks, serial occlusion of the pedicle was begun twice daily. Blood flow and haemoglobin oxygenation of the skin paddle were measured by laser Doppler flowmetry and photometry. At the 14th day of ischaemic preconditioning, the flap could tolerate 3h of occlusion. Then the carrier vessels and the forearm flap were excised. The flap survived completely based on neovascularization from the recipient site.
根据游离皮瓣载体的概念，我们在显微吻合后将带骨皮的腓骨移植到带蒂桡侧前臂皮瓣上，用于重建一名左颈总动脉完全闭塞、右颈总动脉部分闭塞患者的下面部。将腓骨截成三段以形成新的下颌骨，皮瓣置于口外。将外固定装置连接到桡骨上，并将头环固定在颅骨上，从而将前臂牢固地稳定在合适的位置。2周后，开始每天两次对蒂进行系列阻断。通过激光多普勒血流仪和光度测定法测量皮瓣的血流和血红蛋白氧合情况。在缺血预处理的第14天，皮瓣能够耐受3小时的阻断。然后切除供血血管和前臂皮瓣。基于受区的新生血管形成，皮瓣完全存活。
