Politi Massimo, Toro Corrado
Department of Maxillofacial Surgery, University-Hospital S. Maria della Misericordia, Udine, Italy.
J Craniofac Surg. 2012 May;23(3):774-9. doi: 10.1097/SCS.0b013e31824dbd8a.
The mandible is one of the important parts of the body in terms of facial appearance and function. Vascularized free bone grafts have become the criterion standard in mandible reconstruction. With flap survival rates not too much distant to 100%, the focus is now on function and aesthetics. With the various free-flap options now available, reconstruction of the mandibular defect has achieved significant improvement in both functional and aesthetic results. However, few studies have compared the results of these options. The fibula is defined as the most popular flap in mandibular reconstruction, and only in few papers iliac flaps are preferred. However, quality of life and effectiveness data are not available to support this choice. Not any previous study prospectively compared these 2 flaps. Short- and long-term results of an outcome-research study were prospectively compared in microvascular mandibular reconstruction with fibular flap and iliac crest flaps. Mean functional and quality-of-life scores were higher following iliac crest reconstructions. Fibular flap was the flap of choice in total/subtotal mandibulectomy, but it does not appear preferable in hemimandibulectomy and/or in cases of segmental mandibulectomy, if compared with the iliac crest.
就面部外观和功能而言，下颌骨是身体的重要部位之一。带血管蒂的游离骨移植已成为下颌骨重建的标准术式。由于皮瓣成活率接近100%，目前的重点在于功能和美观。随着现在有多种游离皮瓣可供选择，下颌骨缺损的重建在功能和美观效果上都有了显著改善。然而，很少有研究比较这些选择的结果。腓骨被定义为下颌骨重建中最常用的皮瓣，只有少数论文更倾向于使用髂骨皮瓣。然而，目前尚无生活质量和有效性数据支持这一选择。之前没有任何研究对这两种皮瓣进行前瞻性比较。在一项结局研究中，对采用腓骨皮瓣和髂嵴皮瓣进行微血管下颌骨重建的短期和长期结果进行了前瞻性比较。髂嵴重建后的平均功能和生活质量评分更高。在全下颌骨/次全下颌骨切除术中，腓骨皮瓣是首选皮瓣，但与髂嵴相比，在半侧下颌骨切除术和/或节段性下颌骨切除术中，它似乎并非更优选择。
