Innocenti Marco, Menichini Giulio, Lucattelli Elena, Fidanza Anastasia, Innocenti Alessandro
Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy.
Microsurgery. 2021 Nov;41(8):782-786. doi: 10.1002/micr.30813. Epub 2021 Sep 23.
Reconstruction after maxillofacial trauma is extremely challenging. During the past several decades, the chimeric fibular-free flap has emerged as a leading reconstructive option for head and neck compound defects. This report describes a unique case of total mandibular reconstruction using a double-paddle osteocutaneous fibular free flap after facial traumatic injury. A 45-year-old man presented a severe maxillofacial trauma with complete mandibular avulsion. The shortest segment of a 24-cm fibular flap was used to reconstruct the symphysis while the longest segments were placed to rebuild the mandibular body. Microvascular anastomoses were performed with the external jugular vein and facial artery. The distal skin island (10 × 5 cm) was sutured to cover the endo-oral defect while the proximal one (12 × 6 cm) to restore the external tissues continuity of the facial lower third. The postoperative course was uneventful. One year after flap reconstruction, a first commissuroplasty was performed. After 3 months, secondary commissuroplasty was performed with an Estlander flap to rebuild the right lower lip. At latest follow-up, 60 months postoperatively, the patient was able to tolerate soft diet with maximal mouth opening of more than 4 cm; no impairment to mastication, deglutition, or phonation was observed. Speech was normal and the aesthetic outcome was judged good. Double-paddle fibular free flap allows reconstruction of extremely challenging defects, such in case of complete mandibular avulsion. The proximal perforator can provide extended soft-tissue coverage and greater volume than traditional osteocutaneous flaps, avoiding two flaps simultaneous harvest.
颌面创伤后的重建极具挑战性。在过去几十年中，嵌合游离腓骨瓣已成为头颈部复合缺损的主要重建选择。本报告描述了一例面部创伤后使用双叶骨皮游离腓骨瓣进行全下颌骨重建的独特病例。一名45岁男性因严重颌面创伤导致下颌骨完全撕脱。使用一段24厘米腓骨瓣的最短节段重建下颌联合，最长节段用于重建下颌体。将其与颈外静脉和面动脉进行微血管吻合。远端皮岛（10×5厘米）缝合以覆盖口内缺损，近端皮岛（12×6厘米）用于恢复面部下三分之一的外部组织连续性。术后过程顺利。皮瓣重建1年后进行了首次口角成形术。3个月后，使用埃斯特兰德皮瓣进行二期口角成形术以重建右下唇。在术后60个月的最新随访中，患者能够耐受软食，最大开口度超过4厘米；未观察到咀嚼、吞咽或发声功能受损。言语正常，美学效果良好。双叶腓骨游离皮瓣能够重建极具挑战性的缺损，如下颌骨完全撕脱的情况。近端穿支血管能够提供比传统骨皮瓣更大范围的软组织覆盖和更大的组织量，避免了同时切取两个皮瓣。
