Sanger J R, Matloub H S, Yousif N J
Department of Plastic and Reconstructive Surgery, Medical College of Wisconsin, Milwaukee.
Am J Surg. 1990 Oct;160(4):402-4. doi: 10.1016/s0002-9610(05)80553-7.
Microsurgery has improved the success rate for reconstruction of composite defects in the head and neck. Restoration of mandibular continuity alone is not adequate for reconstruction. Replacement of the oral lining with thin tissue is necessary to improve tongue mobility and to set the stage for later dental restoration. There is currently no ideal osteocutaneous free flap that provides unlimited length of bone, can undergo multiple osteotomies to produce the proper curve to the reconstructed mandible, and provides thin skin for oral lining. Combining free flaps can take advantage of the strengths of the individual donor sites and eliminate some of the problems with current osteocutaneous flaps. In six patients, a fibular osseous free flap was combined with either a radial forearm flap or a lateral arm flap to provide bone and oral lining in reconstruction of mandibular composite defects. In these selected patients, the fibula provided the blood supply for the second free flap, which was placed sequentially. The distal peroneal vessels were used to anastomose to the radial forearm vessels or the lateral arm pedicle. This approach allows the surgeon to customize the defect by improving both the functional and aesthetic aspects of reconstruction and is of use in cases where vascular access is limited, such as following head and neck surgery and radiation.
显微外科手术提高了头颈部复合缺损重建的成功率。仅恢复下颌骨的连续性对于重建来说是不够的。用薄组织替代口腔黏膜对于改善舌的活动度以及为后期牙齿修复奠定基础是必要的。目前尚无理想的骨皮瓣，既能提供无限长度的骨，又能进行多次截骨以形成重建下颌骨的合适曲度，还能提供用于口腔黏膜的薄皮肤。联合游离皮瓣可利用各个供区的优势，消除当前骨皮瓣存在的一些问题。在6例患者中，将腓骨游离骨瓣与桡侧前臂皮瓣或上臂外侧皮瓣联合使用，以在重建下颌骨复合缺损时提供骨和口腔黏膜。在这些选定的患者中，腓骨为第二个依次植入的游离皮瓣提供血供。腓骨远端血管用于与桡侧前臂血管或上臂外侧蒂进行吻合。这种方法使外科医生能够通过改善重建的功能和美学方面来定制缺损修复方案，并且在血管通路受限的情况下（如头颈部手术和放疗后）有用。
