Bianchi Bernardo, Ferri Andrea, Ferrari Silvano, Copelli Chiara, Sesenna Enrico
Maxillo-Facial Surgery Division, Head and Neck Department, University and Hospital of Parma, Via Gramsci 14, Parma, Italy.
Microsurgery. 2009;29(6):430-6. doi: 10.1002/micr.20619.
Loss of the maxilla and midfacial bone buttresses after tumor resections can lead to severe functional and esthetic consequences. The loss of palate function may lead to oro-nasal communication, nasal speech, and oral intake difficulties. Several techniques have been proposed for maxillary defects reconstruction including prosthesis, locoregional flaps, or free flaps. The authors propose the use of anterolateral thigh free flap and iliac crest, or calvaria bone graft association for reconstruction of this kind of defects.
Between November 2003 and June 2007, eight patients underwent maxillectomies, with preservation of the orbital contents and simultaneous reconstruction using this technique.
: All the flaps were harvested and transplanted successfully. No major complication occurred and only one patient developed a palatal dehiscence with partial necrosis of the skin of the flap. There were no complications at the donor sites. Speech was assessed as normal in five patients, intelligible in two patients, and poor in one patient. Six patients returned to normal diets, while two patients were restricted to soft diets. The esthetic results were evaluated by the patients themselves as good (in five cases) and acceptable (in two cases). In the remaining case, the esthetic result was deemed to be poor, due to ectropion and poor color matching of the skin used for the external coverage.
The good results obtained using this technique encourage the choice of the association of anterolateral thigh and bone grafts for reconstructing maxillary complex defects.
肿瘤切除术后上颌骨及面中部骨支柱的缺失会导致严重的功能和美学后果。腭部功能丧失可能导致口鼻相通、鼻音及经口进食困难。已提出多种用于上颌骨缺损重建的技术，包括假体、局部皮瓣或游离皮瓣。作者建议使用股前外侧游离皮瓣联合髂嵴或颅骨骨移植来重建此类缺损。
2003年11月至2007年6月期间，8例患者接受了上颌骨切除术，术中保留眶内容物并同时采用该技术进行重建。
所有皮瓣均成功切取并移植。未发生重大并发症，仅1例患者出现腭部裂开，皮瓣皮肤部分坏死。供区无并发症。5例患者语音评估为正常，2例可理解，1例较差。6例患者恢复正常饮食，2例患者限于软食。美学效果经患者自评，5例为良好，2例可接受。其余1例因外翻及用于外部覆盖的皮肤颜色匹配不佳，美学效果较差。
使用该技术取得的良好结果促使我们选择股前外侧皮瓣联合骨移植来重建上颌骨复合缺损。
