Yilmaz Mustafa, Vayvada Haluk, Menderes Adnan, Demirdover Cenk, Kizilkaya Ali
Department of Plastic and Reconstructive Surgery, Dokuz Eylul University, Faculty of Medicine, 35340 Inciralti, Izmir, Turkey.
J Craniofac Surg. 2008 Jan;19(1):227-34. doi: 10.1097/scs.0b013e31815c942c.
Segmental mandibular defects, which are caused either by ablative surgery or trauma, are usually accompanied by different degrees of skin, soft tissue or mucosa losses. The reconstruction of such defects requires complicated surgical procedures. An ideal mandibular reconstruction method must support the insertion osseointegrated dental implants which is necessary for total oral rehabilitation. The soft tissue defect should also be reconstructed if it accompanies the bony defect. We performed 37 mandibular reconstructions using either vascularized iliac crest flap or fibula flap. Sixteen of 24 patients who underwent mandibular reconstruction using iliac crest flap, and 3 of 13 patients who has been reconstructed with fibula flaps, had mandibular defects involving skin and/or mucosa. Both techniques were compared regarding patients records such as hospital stay, operation time, defect size, etiopathogenesis, skin paddle, blood transfusion, and complication rates. Self-assessment questionnaires were also used to evaluate aesthetic and functional results. When 2 different mandibular reconstruction techniques are compared regarding patient records, the complication rate of fibula flap was less than the iliac crest flap. Functional and aesthetic results also showed that oral continence, social activities, and facial appearance rates of fibula flap were superior to iliac crest flap. Lower complication rates of fibula flap group may be associated with patients' higher satisfaction rate. Both flaps are commonly used in mandibular reconstruction, however, many parameters including defect localization, defect size, presence of soft tissue defect should be considered.
节段性下颌骨缺损，无论是由切除性手术还是外伤引起，通常都伴有不同程度的皮肤、软组织或黏膜缺损。此类缺损的重建需要复杂的外科手术。理想的下颌骨重建方法必须支持植入骨整合牙种植体，这是全口修复所必需的。如果伴有骨缺损，软组织缺损也应进行重建。我们使用带血管蒂的髂嵴皮瓣或腓骨皮瓣进行了37例下颌骨重建。在24例行髂嵴皮瓣下颌骨重建的患者中，有16例，在13例行腓骨皮瓣重建的患者中，有3例存在涉及皮肤和/或黏膜的下颌骨缺损。对两种技术的患者记录进行了比较，如住院时间、手术时间、缺损大小、病因、皮瓣、输血情况和并发症发生率。还使用了自我评估问卷来评估美学和功能结果。当比较两种不同的下颌骨重建技术的患者记录时，腓骨皮瓣的并发症发生率低于髂嵴皮瓣。功能和美学结果还表明，腓骨皮瓣的口腔节制、社交活动和面部外观评分优于髂嵴皮瓣。腓骨皮瓣组较低的并发症发生率可能与患者较高的满意度有关。两种皮瓣都常用于下颌骨重建，然而，应考虑许多参数，包括缺损部位、缺损大小、软组织缺损的存在情况。
