Dou Chun-Bo, Gao Xiao-Pei, Yu Zi-Li, Jia Jun
Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, 430079, Wuhan, China; Dongfeng Stomatological Hospital, Hubei University of Medicine, 442000, Shiyan, China.
Dongfeng Stomatological Hospital, Hubei University of Medicine, 442000, Shiyan, China.
J Craniomaxillofac Surg. 2025 Jan;53(1):66-74. doi: 10.1016/j.jcms.2024.10.009. Epub 2024 Nov 2.
This study summarizes and analyzes the characteristics of deep circumflex iliac artery (DCIA) flap reconstruction for maxillary defects and proposes a generalized protocol under the guidance of computer-assisted technique to enhance surgical efficiency and success rate.
We retrospectively reviewed 10 cases of maxillary defects reconstructed using DCIA flaps under the application of computer-assisted technique, collecting clinical data for statistical analysis.
These cases included 2 cystic lesions, 2 mucinous tumors, 2 ameloblastomas, 1 mucoepidermoid carcinoma, 1 odontogenic fibroma, 1 bone defect following squamous cell carcinoma (SCC) surgery, and 1 ossifying fibroma. According to Brown's classification system, there were 7 Type IIb defects, 1 Type IId defect, 1 Type IIIb defect, and 1 Type IIId defect. The length of the iliac bone harvested ranged from 42 mm to 100 mm, and the width from 20 mm to 51 mm. In 7 patients, chimeric iliac myofascial flaps were used; in 2 patients, deep circumflex iliac artery perforator (DCIAP) flaps were utilized; and in 1 patient, a vascularized iliac crest was employed. The recipient vessels were the facial artery and vein in all cases. Intraoral anastomoses were performed in 4 cases, and submandibular anastomoses in 6 cases. The donor site was chosen from the ipsilateral ilium in 8 patients and from the contralateral ilium in 2 patients. The mean operative time was 8.74 hours. Postoperatively, 9 patients recovered well without any complications, while 1 patient experienced necrosis of the bone flap on the first day after surgery and underwent secondary reconstruction using a vascularized fibula flap. The average postoperative hospital stay was 8.6 days.
The combination of DCIA flaps with computer-assisted technique provides a reliable method for the reconstruction of maxillary defects and functional restoration. Establishing generalized procedures could facilitate its broader application.
本研究总结并分析旋髂深动脉（DCIA）皮瓣修复上颌骨缺损的特点，并在计算机辅助技术的指导下提出通用方案，以提高手术效率和成功率。
我们回顾性分析了10例在计算机辅助技术应用下采用DCIA皮瓣修复上颌骨缺损的病例，收集临床资料进行统计分析。
这些病例包括2例囊性病变、2例黏液性肿瘤、2例成釉细胞瘤、1例黏液表皮样癌、1例牙源性纤维瘤、1例鳞状细胞癌（SCC）手术后的骨缺损以及1例骨化性纤维瘤。根据布朗分类系统，有7例IIb型缺损、1例IId型缺损、1例IIIb型缺损和1例IIId型缺损。所取髂骨长度为42毫米至100毫米，宽度为20毫米至51毫米。7例患者采用了嵌合髂肌筋膜皮瓣；2例患者采用了旋髂深动脉穿支（DCIAP）皮瓣；1例患者采用了带血管蒂髂嵴。所有病例的受区血管均为面动脉和面静脉。4例进行了口内吻合，6例进行了下颌下吻合。8例患者的供区选在同侧髂骨，2例患者的供区选在对侧髂骨。平均手术时间为8.74小时。术后，9例患者恢复良好，无任何并发症，而1例患者在术后第一天出现骨瓣坏死，随后采用带血管蒂腓骨皮瓣进行了二次修复。术后平均住院时间为8.6天。
DCIA皮瓣与计算机辅助技术相结合为上颌骨缺损的修复和功能重建提供了一种可靠的方法。制定通用程序有助于其更广泛的应用。
