Gong Zhao-Jian, Zhang Shuai, Zhang Sheng, Liu Jiang, Xu Yu-Ming, Wu Han-Jiang
Visiting Physician, Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital, Central South University, Changsha, China.
Resident, Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital, Central South University, Changsha, China, and Department of Clinical Medicine, Fujian Medical University, Fuzhou, China.
J Oral Maxillofac Surg. 2017 Jun;75(6):1283-1292. doi: 10.1016/j.joms.2016.11.025. Epub 2016 Dec 13.
The reconstruction of massive through-and-through oromandibular defects is still a challenge because no single adequate candidate for a donor site of vascularized bone and a large amount of soft tissue has yet been found. The aim of this study was to evaluate the feasibility and reconstructive efficacy of the combined fibula flap and anterolateral thigh (ALT) flap in tandem for the reconstruction of such defects.
We performed a retrospective case series of patients who had undergone reconstruction of through-and-through oromandibular defects with the combined fibula flap and ALT flap in tandem from January 2012 through December 2014 at the Second Xiangya Hospital. The flap design and the methods for defect reconstruction are described, and the reconstructive efficacy is reported.
Of the 14 patients, 13 were men and 1 was a woman, with an average age of 49.36 years. Postoperatively, all flaps survived completely, without vascular compromise or major wound complications. All of the donor sites were closed directly, leaving only linear scars and no thigh or leg motor dysfunction. All patients were followed for approximately 12 to 48 months, and the appearance and oral functions were acceptably recovered in about 90% of the patients.
Because of the convenient flap design, satisfactory functional and esthetic results, and lower complication rates at the donor and recipient sites, the use of a combined fibula flap and ALT flap in tandem is a good choice for the reconstruction of complex through-and-through oromandibular defects.
大面积贯通性口颌部缺损的重建仍然是一项挑战，因为尚未找到单一合适的带血管化骨及大量软组织的供区。本研究的目的是评估联合腓骨瓣和股前外侧（ALT）皮瓣串联用于重建此类缺损的可行性及重建效果。
我们对2012年1月至2014年12月在中南大学湘雅二医院接受联合腓骨瓣和ALT皮瓣串联重建贯通性口颌部缺损的患者进行了回顾性病例系列研究。描述了皮瓣设计及缺损重建方法，并报告了重建效果。
14例患者中，男性13例，女性1例，平均年龄49.36岁。术后，所有皮瓣均完全存活，未出现血管危象或严重伤口并发症。所有供区均直接缝合，仅留线性瘢痕，大腿或小腿无运动功能障碍。所有患者均随访约12至48个月，约90%的患者外观及口腔功能恢复良好。
由于皮瓣设计简便、功能和美学效果满意、供区和受区并发症发生率较低，联合腓骨瓣和ALT皮瓣串联用于重建复杂的贯通性口颌部缺损是一种不错的选择。
