Wilkman T, Husso A, Lassus P
1 Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
2 Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Scand J Surg. 2019 Mar;108(1):76-82. doi: 10.1177/1457496918772365. Epub 2018 May 6.
: This study compared the three most used composite flaps in maxillofacial reconstructions in our institute.
: Between 2000 and 2012, a total of 163 patients with mandibular, maxillary, and orbital defects received either scapular, fibular, or iliac crest osseal reconstructions in Helsinki University Hospital, Departments of Plastic Surgery and Maxillofacial Surgery. Data regarding the patient demographics, complications, and outcomes were analyzed.
: There were 92 deep circumflex iliac artery flaps (56%), followed by 42 scapular (26%) and 29 fibular flaps (18%). The rate of flap loss was the highest in the deep circumflex iliac artery group (p = 0.001). Reconstructions using fibula were fastest (p = 0.001) and had lowest perioperative blood loss (p = 0.013). There were no significant differences in the number of early or late complications between the flaps, but donor site complications were more severe in deep circumflex iliac artery. Osteotomies as well as dental implants were safely performed in all flaps with equal results.
: All three flaps of this study can be performed with awareness of the deep circumflex iliac artery flap being the least reliable alternative. The knowledge of the advantages and disadvantages of several osseal-free flap alternatives is beneficial in selecting the best suitable method for each individual patient requiring maxillofacial osseal reconstruction.
本研究比较了我院颌面重建中最常用的三种复合组织瓣。
2000年至2012年间，共有163例下颌骨、上颌骨和眼眶缺损患者在赫尔辛基大学医院整形外科和颌面外科接受了肩胛、腓骨或髂嵴骨重建。分析了患者人口统计学、并发症及预后的数据。
共有92例旋髂深动脉瓣（56%），其次是42例肩胛瓣（26%）和29例腓骨瓣（18%）。旋髂深动脉瓣组的组织瓣丢失率最高（p = 0.001）。使用腓骨进行重建最快（p = 0.001），围手术期失血量最低（p = 0.013）。各组织瓣早期或晚期并发症数量无显著差异，但旋髂深动脉瓣供区并发症更严重。所有组织瓣均安全地进行了截骨术及牙种植，效果相同。
本研究中的三种组织瓣均可实施，但应意识到旋髂深动脉瓣是最不可靠的选择。了解几种无骨组织瓣替代方案的优缺点，有助于为每位需要颌面骨重建的患者选择最合适的方法。
