Department of Oral and Maxillofacial Surgery, MacKay Memorial Hospital, Taipei, Taiwan.
Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan.
Microsurgery. 2021 May;41(4):327-334. doi: 10.1002/micr.30729. Epub 2021 Mar 7.
Although two ways of reconstruction have been reviewed for a long period, comparison of large sample size with nearly randomized patient selection is rare. Here, we compare the surgical outcomes of these two methods from two large medical institutes.
Totally 176 patients were included from two medical centers with different protocols, 62 patients from MacKay Hospital repair defects with fibula flaps using reconstruction plates. Also 114 patients from Kaohsiung ChangGung Hospital treat with reconstruction plates combine anterior lateral thigh flaps, in which 12 cases had secondary fibula flap after plate exposure. Electronic medical records were reviewed retrospectively. Short (3-12 months) and long-term (>12 months) outcomes were evaluated.
Short-term evaluation revealed that the secondary fibula had a higher rate of vascular complications (33 vs. 6%, p = .02). Primary fibula had a higher risk of post reconstructive surgical debridement (60 vs. 40%, p = .018). Long-term follow-up revealed radiation therapy significantly worsened bone healing (p = .03). Primary fibula had a lower rate of screw loosening (14.0 vs. 40.3%, p = .002). Radiation therapy did not increase the plate exposure rate among the groups (33 vs. 27%, p = .389). Disease free survival showed no significant difference between two groups (53.1 ± 3.5 vs. 47.8 ± 2.8 months, p = .317).
Primary fibula reconstruction should be considered whenever possible to reduce the risk of late complications and simplifies the management after a potential plate exposure. Notably, radiation therapy apparently has no significant effect on plate exposure rate both in ALT or fibula groups.
尽管已经对两种重建方法进行了长期的回顾，但很少有对近乎随机选择的患者进行大样本量比较的研究。在此，我们比较了来自两个大型医疗机构的这两种方法的手术结果。
共有 176 名患者来自两家医疗中心，采用不同的方案。62 名患者来自马偕纪念医院，使用重建钢板修复腓骨皮瓣缺损。另外 114 名患者来自高雄长庚纪念医院，使用重建钢板联合前外侧股前外侧皮瓣治疗，其中 12 例在钢板暴露后进行了二次腓骨皮瓣。回顾性分析电子病历。评估短期（3-12 个月）和长期（>12 个月）结果。
短期评估显示，二次腓骨的血管并发症发生率更高（33%比 6%，p=0.02）。原发性腓骨在重建后外科清创的风险更高（60%比 40%，p=0.018）。长期随访显示，放疗显著恶化了骨愈合（p=0.03）。原发性腓骨的螺钉松动率较低（14.0%比 40.3%，p=0.002）。放疗并未增加各组的钢板外露率（33%比 27%，p=0.389）。无病生存率在两组之间无显著差异（53.1±3.5 比 47.8±2.8 个月，p=0.317）。
只要可能，应考虑进行原发性腓骨重建，以降低晚期并发症的风险，并简化潜在钢板外露后的管理。值得注意的是，放疗对 ALT 或腓骨组的钢板外露率均无明显影响。
