Prasad Jessica, Sahovaler Axel, Theurer Julie, Yeh David H, Fung Kevin, MacNeil S Danielle, Yoo John, Nichols Anthony C
Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
General Surgery Department, Head and Neck Surgery Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
Microsurgery. 2018 Sep;38(6):682-689. doi: 10.1002/micr.30349. Epub 2018 Jun 29.
Plate extrusions after free tissue transfer for mandibular reconstruction can be problematic and generally require revision surgery. Our objective was to assess the predictors of plate extrusion and compare outcomes between fibular free flaps (FFF), lateral border scapular flaps (LBSF), and scapular tip free flaps (STFF).
Retrospective review of consecutive patients who underwent osseous free tissue reconstruction of the mandible (2008-2014) at Victoria Hospital, London, Ontario. Patient demographics and treatment-related information were collected.
We identified 134 procedures and 27 (20.2%) plate extrusions (21/61 FFF, 3/49 STFF, and 3/24 LBSF). Freedom from extrusion after 2 years was significantly associated with the use of FFF (P = .003, HR 6.09 1.82-20.44), performing 1 osteotomy (P = .03, HR 2.61 1.08-6.31), and anterior mandibular defects (P = .01, HR 2.66 1.25-5.66) in the univariate model. FFF's were employed more frequently in younger patients, with 2.4 mm plates, more anterior defects, and with a greater number of osteotomies (P < .001). However, after controlling for these variables in multivariate analyses the use of a FFF was the only significant predictor of extrusion at 2 years (P = .006, HR 3.68 1.46-9.28).
At our institution, use of the STFF predicts mandibular defects that are less prone to developing plate extrusion and FFF tended to be used more frequently in anterior defects with osteotomies. However, after controlling for these factors use of the FFF appeared to have higher rates of extrusion than scapular flaps. Further prospective studies controlling for defect variables are needed to elucidate the risk factors for plate extrusion.
用于下颌骨重建的游离组织移植术后钢板外露可能会引发问题，通常需要进行翻修手术。我们的目的是评估钢板外露的预测因素，并比较腓骨游离皮瓣（FFF）、肩胛外侧缘皮瓣（LBSF）和肩胛尖游离皮瓣（STFF）的治疗效果。
对安大略省伦敦市维多利亚医院（2008 - 2014年）连续接受下颌骨骨性游离组织重建的患者进行回顾性研究。收集患者的人口统计学资料和与治疗相关的信息。
我们确定了134例手术，其中27例（20.2%）出现钢板外露（21例/61例FFF，3例/49例STFF，3例/24例LBSF）。在单因素模型中，2年后无钢板外露与使用FFF（P = 0.003，HR 6.09 1.82 - 20.44）、进行1次截骨术（P = 0.03，HR 2.61 1.08 - 6.31）以及下颌骨前部缺损（P = 0.01，HR 2.66 1.25 - 5.66）显著相关。FFF在年轻患者中使用更频繁，使用2.4毫米的钢板，前部缺损更多，截骨术次数更多（P < 0.001）。然而，在多因素分析中对这些变量进行控制后，使用FFF是2年后钢板外露的唯一显著预测因素（P = 0.006，HR 3.68 1.46 - 9.28）。
在我们机构，使用STFF预示下颌骨缺损较少发生钢板外露，而FFF在有截骨术的前部缺损中使用更频繁。然而，在控制这些因素后，FFF的钢板外露率似乎高于肩胛皮瓣。需要进一步进行控制缺损变量的前瞻性研究，以阐明钢板外露的危险因素。
