Schusterman M A, Reece G P, Kroll S S, Weldon M E
Reconstructive Plastic Surgery Service, University of Texas M.D. Anderson Cancer Center, Houston.
Plast Reconstr Surg. 1991 Oct;88(4):588-93. doi: 10.1097/00006534-199110000-00005.
Free vascularized bone grafts have revolutionized mandibular reconstruction, yet their use in all mandibulectomy patients is not always necessary. A recently developed alternative to bony reconstruction has been the use of the AO reconstruction plate. We compared the use of the AO reconstruction plate with immediate free bone graft mandibular reconstruction in 31 patients. Reconstruction plates were used in 20 and immediate free bone grafts were used in 11 patients. The overall success rate for use of the plate was 15 of 20 (75 percent). There were 6 anterior reconstructions, of which only 2 (33 percent) were successful. This is opposed to 13 of 14 (93 percent) lateral reconstructions that were successful in lateral plate placements. There were 11 immediate composite free flaps: 4 iliac crest, 4 scapula, 2 fibula, and 1 composite radial forearm flaps. Six repairs were for anterior defects, and there were 5 full-thickness defects, 3 of which were in the anterior position. All 11 flaps were successful. In conclusion, we believe the reconstruction plates are a useful adjunct for mandibular replacement in the head and neck cancer patient but should be reserved for lateral defects. For anterior reconstructions, even in patients with locally advanced disease, free-tissue transfer of composite osteocutaneous flaps is the reconstructive method of choice.
带血管蒂游离骨移植彻底改变了下颌骨重建技术，但并非所有下颌骨切除患者都有必要使用。最近开发的一种骨重建替代方法是使用AO重建钢板。我们比较了31例患者使用AO重建钢板与即刻游离骨移植下颌骨重建的效果。20例患者使用了重建钢板，11例患者使用了即刻游离骨移植。使用钢板的总体成功率为20例中的15例（75%）。有6例前部重建，其中仅2例（33%）成功。相比之下，14例外侧重建中有13例（93%）在外侧钢板植入时成功。有11例即刻复合游离皮瓣：4例取自髂嵴，4例取自肩胛骨，2例取自腓骨，1例取自桡骨前臂复合皮瓣。6例修复前部缺损，有5例全层缺损，其中3例位于前部。所有11例皮瓣均成功。总之，我们认为重建钢板是头颈癌患者下颌骨置换的有用辅助手段，但应仅用于外侧缺损。对于前部重建，即使是局部晚期疾病的患者，复合骨皮瓣的游离组织转移也是首选的重建方法。
