Kaohsiung, Taiwan; and Pittsburgh, Pa. From the Departments of Plastic and Reconstructive Surgery and Rehabilitation and Physical Therapy, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, College of Medicine, and the Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center.
Plast Reconstr Surg. 2011 Jul;128(1):137-145. doi: 10.1097/PRS.0b013e318218fc70.
The free fibular flap has become the workhorse flap for composite mandibular defect reconstruction. As advancements in microsurgery have improved flap survival, greater interest has shifted toward flap refinements to avert donor-site morbidities.
A total of 27 free fibular flaps used for mandible reconstruction were studied prospectively. Of the 27 flaps, 18 suprafascial and nine subfascial dissections were performed. A questionnaire was developed and completed by all patients to assess qualitative aspects of donor-site morbidity and function. Quantitative studies focused on bilateral isokinetic testing of each patient's lower extremities by comparing and quantifying the ankle function.
For the subfascial group, 42 percent of patients complained of pain and alteration in sensation. These donor-site morbidities within the suprafascial group were negligible. Using the Wilcoxon rank sum test, scores obtained from the questionnaires were analyzed, with significant differences seen in wound problems/cosmetic appearance between the two groups (p = 0.0114). For the subfascial group, the donor leg showed significantly less range of motion in plantar-flexion exercises (p = 0.03). Comparing the isokinetic examination results of the suprafascial and subfascial groups, a significant decrease in ankle dorsiflexion, plantar flexion, and foot eversion was evident in the subfascial group.
The qualitative or subjective perception of donor-site morbidity, for the suprafascial method of fibular flap harvest, is relatively low. Quantitative analysis revealed that this method did not cause decreases in ankle function, and it had superior contour and aesthetic outcomes compared with the conventional, subfascial method.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.(Figure is included in full-text article.).
游离腓骨瓣已成为复合下颌骨缺损重建的主力皮瓣。随着显微外科技术的进步提高了皮瓣的存活率，人们对皮瓣的改进更感兴趣，以避免供区并发症。
前瞻性研究了 27 例用于下颌骨重建的游离腓骨瓣。在 27 例皮瓣中，18 例行筋膜上解剖，9 例行筋膜下解剖。设计并完成了一份问卷，由所有患者评估供区并发症和功能的定性方面。定量研究侧重于通过比较和量化每位患者下肢的双侧等速测试，来研究每个患者的腓骨下脚的功能。
在筋膜下组中，42%的患者抱怨疼痛和感觉改变。筋膜上组的这些供区并发症可忽略不计。使用 Wilcoxon 秩和检验分析问卷评分，两组之间在伤口问题/美容外观方面存在显著差异（p=0.0114）。对于筋膜下组，供体腿在跖屈运动中表现出明显较小的运动范围（p=0.03）。比较筋膜上和筋膜下组的等速检查结果，筋膜下组的踝关节背屈、跖屈和足外翻的活动度明显降低。
筋膜上腓骨皮瓣采集方法的供区并发症的定性或主观感知相对较低。定量分析表明，这种方法不会导致踝关节功能下降，与传统的筋膜下方法相比，它具有更好的轮廓和美学效果。
临床问题/证据水平：治疗，II。（全文中包含图表。）
