Taylor G Ian, Corlett Russell J, Ashton Mark W
Melbourne, Victoria, Australia.
From the Jack Brockhoff Reconstructive Plastic Surgery Research Unit-Taylor Laboratory, Department of Anatomy and Neuroscience, University of Melbourne.
Plast Reconstr Surg. 2016 Apr;137(4):1292-1305. doi: 10.1097/PRS.0000000000002040.
The first successful free vascularized bone flap was performed on June 1, 1974 (and reported in 1975), using the fibula. This was followed by the iliac crest based on the superficial circumflex iliac artery in 1975 and then the deep circumflex iliac artery in 1978.
A total of 384 transfers using fibula (n = 198), iliac crest (n = 180), radius (n = 4), rib (n = 1), and metatarsal (n = 1) were used between June of 1974 and June of 2014 for reconstruction of the mandible (n = 267), maxilla (n = 20), clavicle (n = 1), humerus (n = 8), radius and ulna (n = 21), carpus (n = 3), pelvis (n = 2), femur (n = 11), tibia (n = 47), and foot bones (n = 4). Indications were tumor ablation (n = 286), trauma (n = 84), osteomyelitis (n = 2), and the congenital deformities hemifacial microsomia (n = 2) and pseudarthrosis of the tibia (n = 9) and ulna (n = 1).
Successful transfer was achieved in 95 percent of patients. Union varied with the recipient bone, from 6 to 8 weeks in the jaw, 2 to 3 months in the upper limb, and 3 to 4 months in the femur and tibia. Union was fastest with iliac crest. The fibula provided easier dissection; it could be raised on either peroneal or anterior tibial vessels; the skin flap could be designed distally; it could be placed centrally in the medullary cavity of long bones; and hairline stress fracture in the lower limb frequently preceded rapid subperiosteal hypertrophy. The fibula lacks sufficient height for osseointegration, whereas iliac crest is ideal. Osteotomies of either bone are possible to straighten or increase curvature.
The fibula is best for long bone or angle-to-angle jaw reconstruction, especially in edentulous patients. Iliac crest is best for hemimandible, curved bones (pelvis, carpus, and metacarpus), and as an alternative for short, straight, 6- to 8-cm-long bone defects.
1974年6月1日首次成功实施了游离带血管蒂骨瓣移植手术（1975年报道），采用的是腓骨。随后在1975年采用了以旋髂浅动脉为蒂的髂嵴骨瓣，1978年采用了以旋髂深动脉为蒂的髂嵴骨瓣。
1974年6月至2014年6月期间，共进行了384例骨瓣移植，其中腓骨（n = 198）、髂嵴（n = 180）、桡骨（n = 4）、肋骨（n = 1）和跖骨（n = 1）用于下颌骨（n = 267）、上颌骨（n = 20）、锁骨（n = 1）、肱骨（n = 8）、桡骨和尺骨（n = 21）、腕骨（n = 3）、骨盆（n = 2）、股骨（n = 11）、胫骨（n = 47）和足部骨骼（n = 4）的重建。适应证包括肿瘤切除（n = 286）、创伤（n = 84）、骨髓炎（n = 2）以及先天性畸形半侧颜面短小畸形（n = 2）、胫骨假关节（n = 9）和尺骨假关节（n = 1）。
95%的患者移植成功。骨愈合时间因受区骨骼而异，下颌骨为6至8周，上肢为2至3个月，股骨和胫骨为3至4个月。髂嵴骨瓣愈合最快。腓骨易于解剖；可在腓血管或胫前血管上掀起；皮瓣可向远端设计；可置于长骨骨髓腔中央；下肢细微应力性骨折常先于快速的骨膜下肥大。腓骨高度不足以进行骨整合，而髂嵴则较为理想。两种骨都可行截骨以矫正或增加弯曲度。
腓骨最适合长骨或角对角度的下颌骨重建，尤其是无牙患者。髂嵴最适合半侧下颌骨、弯曲骨骼（骨盆、腕骨和掌骨），也可作为6至8厘米长的短直骨缺损的替代选择。
