Kenney Peter S, Kiil Birgitte J
Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark.
Plast Reconstr Surg Glob Open. 2020 Sep 24;8(9):e3149. doi: 10.1097/GOX.0000000000003149. eCollection 2020 Sep.
Advanced mandibular osteoradionecrosis is arguably among the most challenging cases for reconstructive head and neck surgeons. Several reconstructive methods for complex mandibular defects have been reported; however, for advanced mandibular osteoradionecrosis, a safe option that minimizes the risk of renewed fistulation and infections is needed. For this purpose, we present a new technique using a fascia-sparing vertical rectus abdominis musculocutaneous flap as protection for a vascularized free fibula graft (FFG). This technique also optimizes recipient site healing and functionality while minimizing donor site morbidity. Our initial experiences from a 4 patient case series are included. Mean operative time was 551 minutes (SD: 81 minutes). All donor sites were closed primarily. Mean time to discharge was 13 days (SD: 7 days), and mean time to full mobilization was 2 days (SD: 1 days). This double free flap technique completely envelops the FFG and plate with nonirradiated muscle. It allows for the transfer of an FFG without a skin island, thus avoiding the need for split skin graft closure. This results in faster healing and minimizes the risk of fibula donor site morbidity. The skin island of the vertical rectus abdominis musculocutaneous flap has the added benefit of providing intraoral lining, which minimizes contractures and trismus. Although prospective long-term studies comparing this approach to other double flap procedures are needed, we argue that this technique is an optimal approach to safeguard the mandibular FFG reconstruction against the inherent risks of renewed complications in irradiated unhealthy tissue.
晚期下颌骨放射性骨坏死无疑是头颈重建外科医生面临的最具挑战性的病例之一。已有多种针对复杂下颌骨缺损的重建方法的报道；然而，对于晚期下颌骨放射性骨坏死，需要一种能将再次形成瘘管和感染风险降至最低的安全选择。为此，我们提出一种新技术，即使用保留筋膜的腹直肌肌皮瓣来保护带血管游离腓骨移植（FFG）。该技术还能优化受区愈合和功能，同时将供区并发症降至最低。我们纳入了4例患者的初步经验。平均手术时间为551分钟（标准差：81分钟）。所有供区均一期关闭。平均出院时间为13天（标准差：7天），平均完全活动时间为2天（标准差：1天）。这种双游离皮瓣技术用未受照射的肌肉完全包裹FFG和钢板。它允许在不带有皮岛的情况下移植FFG，从而避免了植皮闭合的需要。这导致愈合更快，并将腓骨供区并发症的风险降至最低。腹直肌肌皮瓣的皮岛还有提供口内衬里的额外好处，这可将挛缩和牙关紧闭的情况降至最低。尽管需要进行前瞻性长期研究以将这种方法与其他双皮瓣手术进行比较，但我们认为这种技术是一种最佳方法，可保护下颌骨FFG重建免受受照射不健康组织中再次出现并发症的固有风险。
