Jung Hwi-Dong, Nam Woong, Cha In-Ho, Kim Hyung Jun
Department of Oral and Maxillofacial Surgery, Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea.
Asian Pac J Cancer Prev. 2012;13(8):4137-40. doi: 10.7314/apjcp.2012.13.8.4137.
The authors present five cases of combined oral mucosa-mandible defects reconstructed with the vascularized internal oblique-iliac crest myoosseous free flap. This technique has many advantages compared to other conventional methods such as the radial flap, scapula flap, and fibula flap. Vascularized iliac crest flaps provide sufficient high-quality bone suitable for reconstructing segmental mandibular defects. Although fibular flaps allow longer donor bone tissue to be harvested, the iliac crest can provide an esthetic shape for mandibular body reconstruction and also provides sufficient bone height for dental implants. Conventional vascularized iliac crest myoosseous flaps have excessive soft tissue bulk for reconstruction of intraoral soft tissue defects. The modification discussed in the present article can reduce soft tissue volume, resulting in better functional reconstruction of the oral mucosa. Another advantage is that complete replacement of the oral mucosa is observed in as early as one month post-operation. The final mucosal texture is much better than that obtained with other skin paddle flaps, which is especially beneficial for the placement of dental implant prostheses. Donor site morbidity looks to be similar to, if not less than that observed for other modalities in terms of function and esthetics. For combined oral mucosa-mandible defects, the vascularized internal oblique-iliac crest myoosseous free flap shows good results with respect to hard and soft tissue reconstruction.
作者介绍了5例采用带血管蒂的内斜髂嵴肌骨游离皮瓣修复口腔黏膜-下颌骨联合缺损的病例。与其他传统方法（如桡侧皮瓣、肩胛皮瓣和腓骨皮瓣）相比，该技术具有许多优势。带血管蒂的髂嵴皮瓣能提供足够的高质量骨，适合修复节段性下颌骨缺损。虽然腓骨皮瓣可获取更长的供骨组织，但髂嵴可为下颌体重建提供美观的外形，也能为牙种植提供足够的骨高度。传统的带血管蒂髂嵴肌骨皮瓣用于修复口腔内软组织缺损时软组织量过多。本文所讨论的改良方法可减少软组织体积，从而更好地功能性重建口腔黏膜。另一个优点是术后早在1个月时就能观察到口腔黏膜完全替代。最终的黏膜质地比其他带皮肤瓣的方法要好得多，这对牙种植修复体的植入尤为有利。供区并发症在功能和美观方面看起来与其他方法相似，甚至更少。对于口腔黏膜-下颌骨联合缺损，带血管蒂的内斜髂嵴肌骨游离皮瓣在软硬组织重建方面显示出良好的效果。
