Hidalgo D A, Rekow A
Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, N,Y. USA.
Plast Reconstr Surg. 1995 Sep;96(3):585-96; discussion 597-602.
Sixty consecutive fibula free flap mandible reconstructions were performed for oncologic defects. Patient age averaged 46.7 years. Eighty-one percent were primary reconstructions. Sixty-two percent were lateral defects; 22 percent were anterior; and the remainder had combined defects. The bone gap averaged 9.4 cm. A skin island was included with the fibula in 85 percent of patients but was actually needed in only 62 percent. Miniplate fixation was used in 96 percent. Templates derived from radiographic studies were used as an aid in shaping the fibula. Average anesthesia time was 14.54 hours; the transfusion requirement, 3 units; and hospitalization, 22 days. Fifty-nine flaps were successfully transferred. Ninety percent of skin islands raised were completely viable. Average postoperative interincisal opening was 35.2 mm. Osseointegrated implants were placed in 56 percent of suitable candidates, and all implants integrated into bone. Aesthetic results were usually good when the soft tissue defect was limited, but poor when it was extensive. Donor site morbidity was usually mild and transient. The most significant problem was delayed healing in patients closed with a skin graft. Postoperatively, all patients ambulated normally, and none used assist devices. Reoperation for donor site problems was rare. The fibula has many assets that together make it an ideal choice for the reconstruction of most mandible defects. The skin island is usually reliable if it is designed and raised properly. Donor site morbidity is largely inconsequential. The primary contraindication to the use of the fibula for mandible reconstruction is severe peripheral vascular disease.
对60例因肿瘤缺损而连续进行了游离腓骨瓣下颌骨重建术。患者平均年龄46.7岁。81%为一期重建。62%为外侧缺损；22%为前部缺损；其余为联合缺损。骨缺损平均为9.4厘米。85%的患者腓骨带有皮岛，但实际仅62%的患者需要皮岛。96%采用微型钢板固定。利用影像学研究所得模板辅助腓骨塑形。平均麻醉时间为14.54小时；输血量为3个单位；住院时间为22天。59个皮瓣成功转移。所掀起皮岛90%完全存活。术后平均切牙间开口度为35.2毫米。56%的合适患者植入了骨整合种植体，且所有种植体均与骨整合。当软组织缺损有限时美学效果通常良好，但缺损广泛时则较差。供区并发症通常轻微且短暂。最显著的问题是采用植皮闭合创口的患者愈合延迟。术后，所有患者均能正常行走，无一使用辅助装置。因供区问题再次手术的情况罕见。腓骨具有诸多优点，使其成为大多数下颌骨缺损重建的理想选择。如果皮岛设计和掀起得当，通常是可靠的。供区并发症大多无关紧要。使用腓骨进行下颌骨重建的主要禁忌证是严重的外周血管疾病。
