Lee Michael J, Ondra Stephan L, Mindea Stefan A, Fine Neil A, Dumanian Gregory A
Division of Plastic Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, Ill, USA.
Plast Reconstr Surg. 2005 Jul;116(1):1-7. doi: 10.1097/01.prs.0000169710.53269.bc.
Anterior cervical spine arthrodesis for large defects using autograft or allograft fibula for anterior structural support is a widely accepted procedure. In unique demand situations, a vascularized fibular flap is regarded as an "improvement" to the standard procedure. While a vascularized flap does deliver living tissue to the region, it does so with added potential morbidity and increased technical demand. The indications in the literature for this procedure have not been clearly defined. In this article, the authors review specific high-demand situations where they believe a vascularized flap is indicated. They also review patient outcomes after this procedure.
Fibular free flaps were used in six patients with failed previous cervical spine arthrodeses. Three of the six patients had preoperative radiation therapy, and one received postoperative radiation treatment. All six patients had tumor and/or osteomyelitis present.
One patient died of intraoperative hypotension 3 days after a successful free flap transfer during an elective posterior spine instrumentation procedure. One flap was lost from a venous thrombosis, and the patient was then treated successfully with a second fibular free flap. Clinical and radio-graphic evidence of fusion was obtained at 3 months in the five surviving patients, and neurologic function remained stable or improved.
Analyzing their results and the literature, the authors propose that fibular free flaps are indeed a useful adjunct in difficult cervical spine stabilization procedures. Indications for this flap include combinations of the following situations: failed prior attempts at fusion, anterior cervical arthrodeses of three or more vertebral levels, osteomyelitis of the spine, and tumor cases when the spine has been or will be radiated.
使用自体骨或同种异体腓骨进行前路结构性支撑以治疗颈椎前路大缺损的融合术是一种广泛接受的手术方法。在特殊需求情况下，带血管蒂腓骨瓣被视为标准手术的一种“改进”。虽然带血管蒂瓣确实能将活组织输送到该区域，但这样做会增加潜在的发病率并提高技术要求。该手术在文献中的适应证尚未明确界定。在本文中，作者回顾了他们认为适合使用带血管蒂瓣的特定高需求情况。他们还回顾了该手术后的患者预后。
对6例先前颈椎融合术失败的患者使用了游离腓骨瓣。6例患者中有3例术前接受了放疗，1例接受了术后放疗。所有6例患者均存在肿瘤和/或骨髓炎。
1例患者在择期后路脊柱内固定手术中成功进行游离瓣转移3天后死于术中低血压。1例瓣因静脉血栓形成而失败，该患者随后成功接受了第二次游离腓骨瓣治疗。5例存活患者在3个月时获得了融合的临床和影像学证据，神经功能保持稳定或改善。
通过分析他们的结果和文献，作者提出游离腓骨瓣确实是困难颈椎稳定手术中的一种有用辅助手段。该瓣的适应证包括以下情况的组合：先前融合尝试失败、三个或更多椎体节段的颈椎前路融合术、脊柱骨髓炎以及脊柱已接受或将要接受放疗的肿瘤病例。
