Trignano Emilio, Fallico Nefer, Faenza Mario, Rubino Corrado, Chen Hung-Chi
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, 40447, Taiwan, Republic of China.
Department of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Viale del Policlinico 151, 00161, Rome, Italy.
Microsurgery. 2013 Oct;33(7):527-33. doi: 10.1002/micr.22159. Epub 2013 Aug 14.
In microvascular transfer of fibular osteocutaneous flap for mandible reconstruction after cancer ablation, good bone union is necessary to allow timely radiation therapy after surgery. As the area of bone contact between fibula and the original mandible at the edge of the mandibular defect is small, a periosteal excess at both ends of the fibula covering the bone junction can be used to increase the chance of bone union. The purpose of this study is to investigate whether a periosteal excess surrounding both ends of the fibula flap can provide better blood supply and, therefore, ensure bone union and wound healing at 6 weeks after surgery and before radiation therapy initiation.
The transfer of fibular osteocutaneous flap with periosteal excess was only applied to reconstruct segmental mandibular defects. As a consequence, only cases in which osteotomy of fibula was not performed were included in this study. A total of 34 fibular flaps without osteotomies were performed between 2000 and 2008; 17 with and 17 without the periosteal excess. The bone union was evaluated in terms of osseous callus formation using X-rays and CT three-dimensional images at 6 weeks after surgery, and results were assessed by three independent radiologists.
There was a significant difference between reconstructions with and without the periosteal excess in terms of bone union (P = 0.022). With reference to postoperative complications, the group reconstructed without periosteal excess presented a higher number of complications, mainly consisting of partial and total flap necrosis, respectively six (35.29%) and two (11.76%) cases. In the group reconstructed with periosteal excess, no loss of the skin island has occurred. A significant difference was observed in terms of partial flap necrosis (P = 0.024), while the other complications did not reveal a statistically significant difference (P > 0.05).
The use of a periosteal excess at both ends of the fibula flap provides better blood supply and is, therefore, able to ensure good bone healing and skin paddle survival regardless of the radiotherapy.
在采用腓骨骨皮瓣微血管转移术进行癌症切除术后下颌骨重建时，良好的骨愈合对于术后及时进行放射治疗至关重要。由于腓骨与下颌骨缺损边缘处原下颌骨之间的骨接触面积较小，腓骨两端覆盖骨连接处的骨膜多余部分可用于增加骨愈合的几率。本研究的目的是调查腓骨瓣两端周围的骨膜多余部分是否能提供更好的血液供应，从而确保术后6周且在开始放射治疗前实现骨愈合和伤口愈合。
带有骨膜多余部分的腓骨骨皮瓣转移仅用于重建节段性下颌骨缺损。因此，本研究仅纳入未进行腓骨截骨的病例。2000年至2008年间共进行了34例未行截骨的腓骨瓣手术；其中17例带有骨膜多余部分，17例没有。术后6周时，使用X射线和CT三维图像根据骨痂形成情况评估骨愈合情况，结果由三位独立的放射科医生进行评估。
在骨愈合方面，有骨膜多余部分与没有骨膜多余部分的重建之间存在显著差异（P = 0.022）。关于术后并发症，未带有骨膜多余部分重建的组出现的并发症更多，主要分别为部分和全部皮瓣坏死，各有6例（35.29%）和2例（11.76%）。在带有骨膜多余部分重建的组中，未发生皮岛丢失。在部分皮瓣坏死方面观察到显著差异（P = 0.024），而其他并发症未显示出统计学显著差异（P > 0.05）。
在腓骨瓣两端使用骨膜多余部分可提供更好的血液供应，因此，无论是否进行放射治疗，都能够确保良好的骨愈合和皮瓣存活。
