From the Department of Plastic Surgery, Shriner's Hospitals for Children; Division of Plastic, Reconstructive, and Cosmetic Surgery, University of Illinois-Chicago; and Division of Plastic Surgery, Northwestern University Feinberg School of Medicine.
Plast Reconstr Surg. 2022 Nov 1;150(5):1099-1103. doi: 10.1097/PRS.0000000000009640. Epub 2022 Sep 2.
The fibula flap is the workhorse for mandibular reconstruction, but fibula bone width is not ideal to match mandibular height. In this study, in situ widening of the fibula with distraction osteogenesis before transfer is evaluated as a solution. The authors present a proof of concept of this technique with a patient series, including one patient who has undergone subsequent orthognathic surgery of the reconstructed mandible.
A retrospective review of patients undergoing the authors' technique was performed. A longitudinal fibula osteotomy was made in situ and distraction was performed in the leg to widen the fibula. After distraction and consolidation periods, flaps were osteotomized and transferred to the mandible.
This technique was applied to three patients (ages 9, 11, and 13 years) with Pruzansky III mandibular hypoplasia at the authors' institution over 15 years. In all cases, bony union was achieved. Mean surgical follow-up was 5 years. No significant morbidity occurred at the donor sites. Partial flap resorption was observed a number of years postoperatively in one patient. Temporomandibular joint ankylosis developed in one patient after closed treatment of an unrelated mandible fracture. A sinus tract developed in one patient, requiring débridement of a partial flap necrosis. One patient had orthognathic surgery, including osteotomy of the fibula.
In situ fibula distraction osteogenesis is a novel technique to prelaminate a fibula flap before transfer to the mandible. This method allows for the reconstruction of challenging mandibular defects without compromising bone height, pedicle length, or the ability to perform orthognathic surgery.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
腓骨瓣是下颌骨重建的主力，但其骨宽度不理想，无法与下颌骨高度匹配。在这项研究中，通过在转移前进行骨牵张成骨术对腓骨进行原位增宽被评估为一种解决方案。作者通过一系列患者展示了该技术的概念验证，其中包括一名接受重建下颌骨后续正颌手术的患者。
对接受作者技术的患者进行回顾性研究。在原位进行腓骨纵向切开，在腿部进行牵张以增宽腓骨。牵张和巩固期后，将皮瓣切开并转移到下颌骨。
这项技术在作者所在机构的 15 年内应用于 3 名患有普卢赞斯基 III 型下颌骨发育不全的患者（年龄分别为 9、11 和 13 岁）。在所有病例中均实现了骨性愈合。平均手术随访时间为 5 年。供区无明显并发症。一名患者在术后多年观察到部分皮瓣吸收。一名患者在闭合治疗无关的下颌骨骨折后发生颞下颌关节强直。一名患者发生窦道，需要清创部分皮瓣坏死。一名患者接受了正颌手术，包括腓骨切开术。
腓骨原位牵张成骨术是一种在将皮瓣转移到下颌骨之前对其进行预分层的新技术。该方法允许重建具有挑战性的下颌骨缺损，而不会影响骨高度、蒂长度或进行正颌手术的能力。
临床问题/证据水平：治疗性，IV 级。
