Division of Plastic Surgery, Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan.
Microsurgery. 2013 Sep;33(6):439-46. doi: 10.1002/micr.22123. Epub 2013 Jul 29.
We have previously described a modified chimeric fibular osteocutaneous flap design based on a combination of a traditional fibular flap and a peroneal artery perforator fasciocutaneous flap for mandible and adjacent soft tissue reconstruction. The purpose of this article is to share our experience with a larger case series utilizing this new technique for mandible and adjacent soft tissue reconstruction after cancer wide excision surgery and a more detailed description on these flaps harvesting procedures.
Ten patients (age range from 32 to 63 years), who had segmental defect of mandible and adjacent soft tissue defect after cancer wide excision surgery, received mandible and adjacent soft tissue reconstruction based on the modified chimeric fibular flap design.
The skin paddle based on peroneal perforators ranged from 9 cm × 3.5 cm to 10 cm × 10 cm and the mean pedicle length was 8.9 cm. Four patients underwent primary closure of the donor site. Three flap salvage procedures were performed due to vascular thrombosis and all flaps survived well. Nine patients had acceptable outer appearance, and one patient complained of cheek sunken. All patients had at least 3-cm interincisor distance during a mean of 12-month follow-up period.
The modified chimeric osteocutaneous fibula flaps were feasible design with few intermuscular septum problems during bone fixation. Furthermore, it provided larger skin paddles with few restrictions to reconstruct the cheek skin defect.
我们之前描述了一种改良的嵌合腓骨骨皮瓣设计,该设计基于传统腓骨瓣和腓动脉穿支筋膜皮瓣的结合,用于下颌骨和相邻软组织的重建。本文的目的是分享我们利用这种新技术进行下颌骨和相邻软组织切除术后重建的更大系列病例经验,并更详细地描述这些皮瓣的采集过程。
10 名患者(年龄 32 至 63 岁),因癌症广泛切除术后下颌骨和相邻软组织缺损,接受了改良嵌合腓骨瓣设计的下颌骨和相邻软组织重建。
基于腓动脉穿支的皮瓣大小为 9cm×3.5cm 至 10cm×10cm,平均蒂长为 8.9cm。4 名患者行供区一期关闭。由于血管血栓形成,进行了 3 次皮瓣挽救手术,所有皮瓣均存活良好。9 名患者外观可接受,1 名患者抱怨脸颊凹陷。所有患者在平均 12 个月的随访期间均有至少 3cm 的切牙间距。
改良的嵌合性腓骨骨皮瓣设计可行,在进行骨固定时很少有肌间隔问题。此外,它提供了更大的皮瓣,很少限制重建脸颊皮肤缺损。