Tiftikcioglu Yigit Ozer, Gur Ersin, Gurler Tahir
Department of Plastic, Reconstructive and Aesthetic Surgery, Ege University Medical School, Izmir, Turkey.
J Craniofac Surg. 2017 Mar;28(2):559-563. doi: 10.1097/SCS.0000000000003342.
The fibula flap is a workhorse flap for bony reconstruction of oro-mandibular area and can be modified to include soft tissue for reconstruction of composite defects. However, the design of a reliable skin paddle that can be used for composite tissue reconstruction remains a challenge. The authors described the applicability of perforator concept for a more reliable free osteomusculocutaneous fibula flap.
Between 2013 and 2015, 29 patients underwent free fibula osteocutaneous flap reconstruction. Twenty-two patients have been operated due to squamous cell carcinoma and 7 patients due to gunshot injuries.
The mean harvesting time was 60 ± 15 minutes. The range of width of the skin paddle was 3 to 12 cm and length was 6 to 23 cm. The range of length of bone was 5 to 18 cm. One patient had revision due to venous occlusion. All flaps have survived.
The authors advocate approaching all components of flap individually using the perforator concept and dissection. Good exposure is mandatory for a reliable dissection. In our opinion, the posterior approach is more useful as it reveals all vascular relationships between the bone, muscle, skin paddle, and peronel vessels.
腓骨瓣是口腔颌面部骨重建的常用皮瓣，可进行改良以包含软组织用于复合缺损的重建。然而，设计一种可用于复合组织重建的可靠皮岛仍然是一项挑战。作者描述了穿支概念在更可靠的游离骨肌皮腓骨瓣中的适用性。
2013年至2015年期间，29例患者接受了游离腓骨骨皮瓣重建。22例患者因鳞状细胞癌接受手术，7例患者因枪伤接受手术。
平均切取时间为60±15分钟。皮岛宽度范围为3至12厘米，长度为6至23厘米。骨长度范围为5至18厘米。1例患者因静脉阻塞进行了翻修。所有皮瓣均存活。
作者主张采用穿支概念和解剖方法分别处理皮瓣的各个组成部分。良好的暴露对于可靠的解剖至关重要。我们认为，后路更有用，因为它能揭示骨、肌肉、皮岛和腓血管之间的所有血管关系。
