Pitak-Arnnop P, Hemprich A, Dhanuthai K, Pausch N C
Department of oral, craniomaxillofacial and facial plastic surgery, scientific unit for clinical and psychosocial research, evidence-based surgery and ethics in oral and maxillofacial surgery, faculty of medicine, University hospital of Leipzig, Leipzig, Germany.
Rev Stomatol Chir Maxillofac Chir Orale. 2013 Feb;114(1):15-8. doi: 10.1016/j.stomax.2012.05.001. Epub 2012 Jun 15.
Fibular free flap is considered as an "old dog" in reconstructive surgery because it was first described by Taylor and his colleagues in 1975, and was then introduced for mandibular reconstruction by Hidalgo in 1989. There are some "tricks" for fibular free flap that have been used and recognized in many European maxillofacial surgical units over the past decade. These include: 1) harvesting the distal fibula when recipient vessels are distant; 2) flap selection based on the anatomy of perforators; 3) use of the skin paddle for postoperative flap monitoring; 4) protection of the flap's soft-tissue cuff; 5) preventing venous thrombosis which is essential to reduce flap complications; 6) aligning fibular struts and protecting the vascular pedicle when the double-barrel technique is used; 7) minimizing the gap between the double-barrel struts and implementing a long-term follow-up of dental implants; 8) selecting osteosynthesis materials; and 9) learning curve and clinical competence in microvascular reconstruction. We also reviewed current data from the literature, which would be useful for maxillofacial reconstructive surgeons. With these tricks, one can teach an "old dog" "old tricks".
腓骨游离皮瓣在重建外科领域被视为“老方法”，因为它最早由泰勒及其同事于1975年描述，随后在1989年由伊达尔戈引入用于下颌骨重建。在过去十年中，许多欧洲颌面外科单位使用并认可了一些腓骨游离皮瓣的“技巧”。这些技巧包括：1）当受区血管距离较远时切取腓骨远端；2）根据穿支血管的解剖结构选择皮瓣；3）使用皮岛进行术后皮瓣监测；4）保护皮瓣的软组织袖套；5）预防静脉血栓形成，这对于减少皮瓣并发症至关重要；6）在使用双柱技术时对齐腓骨支柱并保护血管蒂；7）最小化双柱支柱之间的间隙并对牙种植体进行长期随访；8）选择骨固定材料；9）微血管重建的学习曲线和临床能力。我们还回顾了文献中的现有数据，这对颌面重建外科医生会有所帮助。有了这些技巧，就能让“老方法”焕发出新活力。
