游离腓骨皮瓣重建下颌骨节段切除术后下颌骨的安全性和有效性：回顾性病例对照研究。
Safety and efficacy of secondary mandibular reconstruction using a free osteo-cutaneous fibula flap after segmental mandibular resection: a retrospective case-control study.
机构信息
Division of Plastic and Reconstructive Surgery, Faculty of Medicine Shimane University, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
出版信息
BMC Surg. 2021 Apr 9;21(1):189. doi: 10.1186/s12893-021-01194-3.
BACKGROUND
Free osteocutaneous fibula flap (FFF) is currently considered the best option for segmental mandibular reconstruction; however, there are only a few reports comparing secondary with primary reconstructions using FFF. This study aimed to evaluate the safety and efficacy of secondary mandibular reconstruction using FFF when compared with primary mandibular reconstruction.
METHODS
From October 2018 to February 2020, patients who underwent mandibular reconstruction using FFF after segmental mandibulectomy were retrospectively reviewed. The size and location of the mandibular defect, the segment length and number of osteotomies in the fibula, types of the mandibular plating system, kinds and laterality of the recipient vessels were recorded from the surgical notes. Flap survival, duration of nasogastric tube use, and implant installation after reconstruction were recorded as postoperative evaluation indices.
RESULTS
Twelve patients underwent mandibular reconstruction using FFF during the study period. There were no significant differences in demographic characteristics other than body mass index between the primary (n = 8) and secondary (n = 4) reconstruction groups. No significant differences were observed in the size and location of defects, the segment length and number of osteotomies in the fibula, and the types of mandibular plating system. There was no significant difference in the kinds of recipient vessels; however, the laterality of recipient vessels was ipsilateral in all cases of primary reconstructions and contralateral in all cases of secondary reconstructions. Three out of eight patients with primary FFF reconstruction developed partial flap necrosis. Four patients in the secondary FFF reconstruction group achieved complete flap survival. The duration of use of the nasogastric tube and implant installation after reconstruction was comparable between the two groups.
CONCLUSION
Safe and effective secondary mandibular reconstruction can be performed in this clinical case study using FFF.
背景
游离腓骨肌皮瓣（FFF）目前被认为是节段性下颌骨重建的最佳选择；然而，仅有少数报道比较了使用 FFF 的继发性和原发性重建。本研究旨在评估与原发性下颌骨重建相比，使用 FFF 进行继发性下颌骨重建的安全性和有效性。
方法
回顾性分析 2018 年 10 月至 2020 年 2 月接受节段性下颌骨切除后使用 FFF 进行下颌骨重建的患者。从手术记录中记录下颌骨缺损的大小和位置、腓骨的节段长度和截骨数量、下颌骨接骨板系统的类型、受区血管的类型和侧别。将皮瓣存活、鼻胃管使用时间和重建后植入物安装作为术后评估指标。
结果
研究期间，12 例患者接受 FFF 进行下颌骨重建。原发性（n=8）和继发性（n=4）重建组除体重指数外，其他人口统计学特征无显著差异。缺损的大小和位置、腓骨的节段长度和截骨数量以及下颌骨接骨板系统的类型无显著差异。受区血管的类型无显著差异；然而，所有原发性重建的受区血管均为同侧，而所有继发性重建的受区血管均为对侧。8 例原发性 FFF 重建中有 3 例发生部分皮瓣坏死。继发性 FFF 重建组 4 例患者皮瓣完全存活。两组患者鼻胃管使用时间和重建后植入物安装时间无显著差异。
结论
在本临床病例研究中，使用 FFF 可安全有效地进行继发性下颌骨重建。
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