Thoma A, Allen M, Tadeson B H, Archibald S, Jackson S, Young J E
Division of Plastic and Reconstructive Surgery, St. Joseph's Hospital, Hamilton, Ontario, Canada.
J Reconstr Microsurg. 1995 May;11(3):215-9. doi: 10.1055/s-2007-1006535.
The radial forearm osteocutaneous free flap has become a standard method of mandible reconstruction. In order to improve the contour of the reconstructed jaw in large resections, especially the anterior defect, the radial forearm bone graft needs to be osteotomized. The bone graft is nourished by small branches of the radial artery via the fascial connections between the skin flap and bone. The effect of the osteotomy, fixation devices, and the angulation of the bone segment on bone viability and eventual bone healing is not known. Forty-two radial forearm osteocutaneous flaps were used for composite mandible reconstruction. In 25 patients, the bone graft required osteotomy to achieve contour, of which 16 required single osteotomy and nine required double osteotomy. In a remaining 17 cases, no osteotomy was performed. Only those patients who had at least a 1-year follow-up were included in this study. The proportion of patients who achieved bone union was similar for both groups (i.e. osteotomy vs. nonosteotomy). Performing osteotomies on the segment of the radius in free osteocutaneous transfers is safe, and it allows for more flexibility in reconstruction, to achieve a natural-appearing jaw.
桡骨前臂骨皮瓣已成为下颌骨重建的标准方法。为了改善大面积切除术后重建颌骨的外形，尤其是前部缺损的外形，需要对桡骨前臂骨移植进行截骨。骨移植由桡动脉的小分支通过皮瓣与骨之间的筋膜连接提供营养。截骨、固定装置以及骨段的角度对骨活力和最终骨愈合的影响尚不清楚。42个桡骨前臂骨皮瓣用于复合下颌骨重建。25例患者中，骨移植需要截骨以达到外形要求，其中16例需要单次截骨，9例需要两次截骨。其余17例未进行截骨。本研究仅纳入随访至少1年的患者。两组（即截骨组与非截骨组）实现骨愈合的患者比例相似。在游离骨皮瓣移植中对桡骨段进行截骨是安全的，并且在重建中具有更大的灵活性，以实现外观自然的颌骨。
