Yagi Shunjiro, Kamei Yuzuru, Torii Shuhei
Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Ann Plast Surg. 2006 Jun;56(6):622-7. doi: 10.1097/01.sap.0000205776.18090.9b.
While the free fibular osteocutaneous flap is indispensable for mandibular reconstruction, reliable setting is often difficult because relative positions of the bone, skin island, and vascular pedicle are critical. We have an algorithm for donor-side selection of free fibular osteocutaneous flap. From July 2002 to March 2004, we performed 15 mandibular reconstructions using free fibular osteocutaneous flaps. We retrospectively classified these procedures as follows. In type I (flap harvested ipsilaterally to defect, n = 5), the skin island was fixed to the oral cavity, and the vascular pedicle emerged from the anterior aspect of the fibula. In type II (flap contralateral to defect, n = 5), the skin island was fixed to the oral cavity, and the vascular pedicle arose from the posterior aspect. In type III (flap contralateral to defect, n = 4), the skin island was fixed to the facial skin and the vascular pedicle arose from the anterior aspect. In type IV (flap ipsilateral to defect, n = 1), the skin island was fixed to the facial skin and the vascular pedicle arose from the posterior aspect. Flaps took completely except in 1 group II case with partial necrosis. Close attention to geometric characteristics of a free fibular osteocutaneous flap facilitates reconstruction of mandibular defects and selection of donor side.
尽管游离腓骨骨皮瓣对于下颌骨重建不可或缺，但由于骨、皮岛和血管蒂的相对位置至关重要，可靠的设置往往很困难。我们有一套游离腓骨骨皮瓣供区选择的算法。2002年7月至2004年3月，我们使用游离腓骨骨皮瓣进行了15例下颌骨重建。我们对这些手术进行了如下回顾性分类。I型（皮瓣取自缺损同侧，n = 5），皮岛固定于口腔，血管蒂从腓骨前方穿出。II型（皮瓣取自缺损对侧，n = 5），皮岛固定于口腔，血管蒂从腓骨后方穿出。III型（皮瓣取自缺损对侧，n = 4），皮岛固定于面部皮肤，血管蒂从腓骨前方穿出。IV型（皮瓣取自缺损同侧，n = 1），皮岛固定于面部皮肤，血管蒂从腓骨后方穿出。除1例II型部分坏死外，皮瓣均完全成活。密切关注游离腓骨骨皮瓣的几何特征有助于下颌骨缺损的重建和供区的选择。
