Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.
Division of Plastic Surgery and Reconstructive Surgery, Chuanghua Christian Hospital, Chuanghua, Taiwan, Republic of China.
J Reconstr Microsurg. 2021 Jul;37(6):524-529. doi: 10.1055/s-0040-1722647. Epub 2021 Jan 31.
Osteoradionecrosis (ORN) is one of the most severe complications of free fibula reconstruction after radiotherapy. The gold standard treatment of osteomyelitis involves extensive debridement, antibiotics, and sufficiently vascularized muscle flap coverage for better circulation. Therefore, we hypothesized that free fibula flap with muscle could decrease the risk of ORN.
This study consisted of 85 patients who underwent reconstruction with free fibula flap in head and neck cancer by a single reconstructive surgeon at Kaohsiung Veterans General Hospital over a period of 19 years (1998-2016). Patients with postoperative adjuvant radiotherapy were included in the study and were grouped by either free fibula osteocutaneous flap or free fibula osteomyocutaneous flap (with flexor hallucis longus muscle), and the incidence of ORN was compared.
Of the 85 patients, 15 were reconstructed with osteocutaneous fibula flap and 70 were with osteomyocutaneous fibula flap. The rate of ORN or osteomyelitis was significantly lower in the muscle group (18.6%, = 13/70 vs. 46.7%, = 7/15, = 0.020, Chi-square test).
Vascularized muscle transfer increases perfusion of surrounding tissues and the bone flap, thereby decreasing the incidence of osteomyelitis or osteonecrosis.
放射性骨坏死（ORN）是放疗后游离腓骨重建后最严重的并发症之一。骨髓炎的金标准治疗包括广泛清创、抗生素治疗以及足够的血管化肌肉瓣覆盖以改善循环。因此，我们假设游离腓骨肌瓣可以降低 ORN 的风险。
本研究纳入了 1998 年至 2016 年期间，由同一位重建外科医生在高雄荣民总医院对 85 例头颈部癌症患者进行游离腓骨瓣重建的病例。纳入术后接受辅助放疗的患者，并分为游离腓骨骨皮瓣组和游离腓骨骨肌瓣组（带踇长屈肌），比较 ORN 的发生率。
85 例患者中，15 例采用骨皮瓣游离腓骨重建，70 例采用骨肌瓣游离腓骨重建。肌瓣组的 ORN 或骨髓炎发生率明显较低（18.6%，13/70 例与 46.7%，7/15 例，=0.020，卡方检验）。
带血管化肌肉转移可增加周围组织和骨瓣的灌注，从而降低骨髓炎或骨坏死的发生率。
