Germain M A, Menard P, Bertrand J C, Luboinski B, Schwaab G, Marandas P, Janot F, Julieron M, Hureau J
Service de Chirurgie, Hôpital de Nanterre.
Chirurgie. 1991;117(5-6):445-53.
Free revascularized fibular transplants have been used in surgery for the reconstruction of long bones since 1973. The reconstruction of the mandible using a free fibular transplant has been published in 1989 only by Hidalgo. The mandible and the fibula have little in common, except for their length and a similar structure in section. The anatomical study of the free osteofasciocutaneous fibular graft included 20 fresh subjects. The vascularization of the fasciocutaneous plate is either grouped or, more frequently, tiered (2/3 of cases). The technique to remove this graft is specified. Four clinical cases are reported, including three cases of neoplasm of the floor of the mouth invading the mandible, and one case of traumatic amputation of the lower part of the face. A free composed transplant taken from the fibula has been used in all four cases. The postoperative period was normal, and the grafts were completely successful. The main indications of free transplants made of fibular bone are: extensive (more than 8 cm) or compound losses of bony substance from the mandible. The richly vascularized transplant take from the fibula is very sophisticated and performant. The length of bone that can be removed is 25 cm; the bone may be osteotomized in 2 to 4 fragments retaining their vitality. Other tissular structures such as the skin, fascia, muscle, are removed with the bone. The independence in space is threefold and regards the bone, the teguments and the vascular pedicle. The microsurgical qualities of the vascular pedicle are considerable. These free transplants improve the quality of survival (endosseous implants in one case). The morphological, functional and esthetic result is good as a rule.
自1973年以来，游离血管化腓骨移植已用于长骨重建手术。1989年，只有伊达尔戈发表了使用游离腓骨移植重建下颌骨的相关内容。下颌骨和腓骨除了长度和截面结构相似外，几乎没有共同之处。对20例新鲜标本进行了游离骨筋膜皮瓣腓骨移植的解剖学研究。筋膜皮瓣的血管分布要么成组，要么更常见的是分层分布（2/3的病例）。详细说明了切除该皮瓣的技术。报告了4例临床病例，包括3例侵犯下颌骨的口底肿瘤病例和1例面部下部外伤性截肢病例。所有4例均采用了取自腓骨的游离复合移植。术后恢复正常，移植完全成功。腓骨游离移植的主要适应证为：下颌骨广泛（超过8cm）或复合性骨质缺损。取自腓骨的血管丰富的移植非常精细且性能良好。可切除的骨长度为25cm；骨可被截成2至4段，保持其活力。其他组织结构如皮肤、筋膜、肌肉等与骨一起被切除。在空间上的独立性体现在三个方面，即骨、被覆组织和血管蒂。血管蒂的显微外科特性相当可观。这些游离移植提高了生存质量（其中1例进行了骨内植入）。通常，形态、功能和美学效果良好。
