Tsuge Itaru, Yamanaka Hiroki, Katsube Motoki, Sowa Yoshihiro, Sakamoto Michiharu, Morimoto Naoki
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Plast Reconstr Surg Glob Open. 2022 Nov 16;10(11):e4607. doi: 10.1097/GOX.0000000000004607. eCollection 2022 Nov.
We applied double-flap reconstruction with a vascularized fibula osteo flap and a Y-shaped anterolateral thigh (ALT) flap, which was separated into a fascial flap and a de-epithelialized fat flap to replace the temporomandibular joint capsule and temporal soft tissue volume, respectively. This technique achieved excellent functional and cosmetic results with acceptable operation time and donor site scarring. A 16-year-old girl had a rapidly growing mandibular osteosarcoma. Right mandibulectomy from the right first premolar tooth to right condylar head (including temporalis muscle, masseter muscle, buccal mucosa, and part of the right maxilla) was performed. A left fibula osteo flap and left ALT flap were prepared in a prefabricated manner using a three-dimensional model and a prebent titanium plate. The area of the ALT flap was 23 × 6 cm. A proximal 8 × 4 cm skin flap was positioned to replace the left cheek mucosa, and the distal part was divided into two layers: a de-epithelialized fat flap and a fascial flap. The de-epithelialized fat flap was used to prevent the depression deformation at the temporal area, and the fascial flap was used to cover around the alternate condylar head made by the fibula instead of the resected temporomandibular joint capsule. The peroneal artery and veins were microscopically anastomosed to the distal end of the artery and veins of the descending branch of the ALT flap in a flow-through manner. At 12 months after surgery, the occlusal function and aesthetic balance were excellent.
我们应用带血管蒂腓骨骨瓣和 Y 形股前外侧（ALT）皮瓣进行双瓣重建，将 ALT 皮瓣分离为筋膜瓣和去上皮脂肪瓣，分别用于替代颞下颌关节囊和颞部软组织容量。该技术在可接受的手术时间和供区瘢痕情况下取得了优异的功能和美容效果。一名 16 岁女孩患有快速生长的下颌骨肉瘤。进行了从右侧第一前磨牙至右侧髁突头部的右下颌骨切除术（包括颞肌、咬肌、颊黏膜和部分右上颌骨）。使用三维模型和预弯钛板预制方式制备左侧腓骨骨瓣和左侧 ALT 皮瓣。ALT 皮瓣面积为 23×6cm。近端 8×4cm 的皮瓣用于替代左侧颊黏膜，远端部分分为两层：去上皮脂肪瓣和筋膜瓣。去上皮脂肪瓣用于防止颞部凹陷变形，筋膜瓣用于覆盖由腓骨制成的替代切除的颞下颌关节囊的交替髁突头部周围。腓动脉和静脉在显微镜下以端侧吻合的方式与 ALT 皮瓣降支的动静脉远端吻合。术后 12 个月，咬合功能和美学平衡良好。
