Siciliano S, Savastano G, Reychler H
Cattedra di Chirurgia Maxillo-Facciale, Università degli Studi di Napoli Federico II.
Minerva Stomatol. 1995 Apr;44(4):185-92.
The authors present two clinical cases of mandibular reconstruction using free vascularized bone grafts and dental osseointegrated implants. A wide discussion about the different techniques of reconstruction is reported. Several factors like the clinical history, age, general conditions of patient's health can influence the choices of the surgeon. The characteristics of the different donor sites are described, so the advantages and disadvantages of the different free microvascular flaps are analyzed. According to the authors not only the technical aspects of microsurgery but also a good choice of the right free flap plays an important role in a successful result. The influence of radiotherapy on microvascular reconstruction in the head and neck region is also discussed. The authors recommend the use of fibula and scapula as donor site for reconstruction of complex (i.e. interesting also the adjacent soft tissues, muscles, mucosa and skin) mandibular defects that require more than 6 cm of bone graft length. Corticotomies of bone ensure a perfect adaptation of the graft to the mandibular form with a good aesthetic result, while the use of dental osseointegrated implants allows total masticatory functional rehabilitation. It's important that these techniques must be utilized in well organized hospital centers by experienced surgeons who are able to resolve entirely the problems and needs of the patient.
作者介绍了两例使用带血管游离骨移植和牙种植体进行下颌骨重建的临床病例。文中报道了关于不同重建技术的广泛讨论。一些因素，如临床病史、年龄、患者的总体健康状况，会影响外科医生的选择。描述了不同供区的特点，并分析了不同游离微血管皮瓣的优缺点。作者认为，不仅显微外科技术，而且正确选择游离皮瓣对手术成功也起着重要作用。文中还讨论了放疗对头颈部微血管重建的影响。作者推荐使用腓骨和肩胛骨作为供区，用于重建复杂的（即涉及相邻软组织、肌肉、黏膜和皮肤）下颌骨缺损，这类缺损需要超过6厘米的骨移植长度。骨皮质切开术可确保移植骨与下颌骨形态完美适配，获得良好的美学效果，而使用牙种植体可实现完全的咀嚼功能康复。重要的是，这些技术必须由经验丰富的外科医生在组织完善的医院中心使用，他们能够完全解决患者的问题和需求。
