Thoma A, Heddle S, Archibald S, Young J E
Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Plast Reconstr Surg. 1988 Aug;82(2):291-8. doi: 10.1097/00006534-198808000-00014.
The free vascularized anterior rib graft, one of the earliest free osseous transfers to the head and neck, has not gained widespread acceptance, perhaps due to early reservations concerning the adequacy of the periosteal circulation. The authors present further laboratory evidence, with clinical cases, attesting to the adequacy of the periosteal circulation alone. Our surgical technique varies from other reports in that a substantially greater length of the internal mammary vessels is harvested and includes the dual periosteal supply by means of the supracostal and intercostal vessels, both branches of the internal mammary vessels. This modification is based on anatomic and angiographic findings. The incorporation of both branches enhances the margin of safety in raising this free bone graft.
带血管蒂游离肋骨移植术是最早应用于头颈部的游离骨移植术之一，但尚未得到广泛认可，这可能是由于早期对骨膜血运是否充足存在疑虑。作者通过临床病例提供了进一步的实验室证据，证明仅骨膜血运就足够了。我们的手术技术与其他报道不同之处在于，所获取的胸廓内血管长度要长得多，并且通过作为胸廓内血管分支的肋上血管和肋间血管实现了双重骨膜供血。这种改进是基于解剖学和血管造影学的发现。纳入这两个分支提高了切取这种游离骨移植体时的安全系数。
