Lee J H, Kim M J, Kim J W
Department of Oral and Maxillofacial Surgery, College of Dentistry, Chonnam National University, Kwang-ju, Korea.
J Craniomaxillofac Surg. 1995 Feb;23(1):20-6. doi: 10.1016/s1010-5182(05)80249-5.
Although various sources of vascularized bone/composite tissue have been used for mandibular reconstruction, the vascularized fibular flap has been reported to have many advantages over the others and to be the most suitable for bridging a long-span mandibular defect. In this paper, positive experience of 14 consecutive cases in which a free vascularized fibular graft with or without a skin paddle has been used to reconstruct a long mandibular defect is reported. Half of the cases were primarily reconstructed, the rest secondarily. The average length of the fibula graft harvested was 16.7 cm, with a range of 12 to 22 cm. The number of wedge osteotomies ranged from 0 to 4, with an average of 1.67. In ten flaps, a peroneal skin paddle was included. The donor wound was typically closed directly, except in three cases, where a skin graft was used. Vein grafts were performed in five cases to lengthen the pedicle. In two cases, the skin partially necrosed. All scintigrams except one showed good bone viability. But there was no total flap failure. Postoperative facial appearances were fair to excellent, with mouth opening ranging from 21 to 50 mm. Although unusual serious donor wound rupture was experienced in one case, in general the donor site complications were minimal.
尽管多种带血管蒂的骨/复合组织来源已被用于下颌骨重建，但据报道，带血管蒂的腓骨瓣相较于其他组织瓣具有诸多优势，且最适合修复长节段下颌骨缺损。本文报告了连续14例应用带或不带皮瓣的游离带血管蒂腓骨移植修复长节段下颌骨缺损的成功经验。其中半数病例为一期重建，其余为二期重建。所取腓骨移植段的平均长度为16.7cm，范围在12至22cm之间。楔形截骨的数量为0至4个，平均为1.67个。10个组织瓣带有腓骨皮瓣。除3例采用植皮外，供区伤口通常直接缝合。5例进行了静脉移植以延长蒂部。2例出现皮肤部分坏死。除1例骨闪烁显像外，其余均显示骨存活良好。但未出现组织瓣完全坏死的情况。术后面部外观良好至极佳，开口度在21至50mm之间。尽管有1例出现了罕见的严重供区伤口裂开，但总体而言，供区并发症极少。
