Hoffmeister B, Fleiner B, Dunsche A
Klinik für Mund-, Kiefer- und Gesichtschirurgie im Klinikum der Christian-Albrechts-Universität Kiel.
Fortschr Kiefer Gesichtschir. 1994;39:111-4.
There is a difference in the vascular architecture of myocutaneous flaps and jejunal free flaps both available to replace resected mucosal tissue of the oral cavity after surgical treatment of oral cancer. The question in whether the mobilization of jejunal free flaps is possible without respect to the anastomized vessels in particular in secondary reconstruction procedures to achieve a bony continuity of the mandible. From 1985-1992 22 patients were operated on using microsurgically anastomized jejunal free flaps. In 7 cases a secondary mandibular reconstruction by means of microsurgically anastomized iliac crest grafts was performed. In respect of our results we recommend in cases of secondary mandibular reconstruction with mobilisation of the jejunal flap. 1. preoperative digital subtraction angiography, 2. temporary clamp of anastomized vessels with observation of the perfusion of the jejunal flap, 3. intraoperative doppler-sonography. These techniques allow a save evaluation of the vessels of the donor site prior to microvascular anastomoses for secondary bony reconstruction of the mandible.
用于替代口腔癌手术治疗后切除的口腔黏膜组织的肌皮瓣和空肠游离瓣，其血管结构存在差异。问题在于，尤其是在二次重建手术中，不考虑吻合血管的情况下，空肠游离瓣的调动是否可行，以实现下颌骨的骨连续性。1985年至1992年期间，22例患者接受了显微外科吻合空肠游离瓣手术。7例患者通过显微外科吻合髂嵴移植进行了二次下颌骨重建。基于我们的结果，对于二次下颌骨重建并调动空肠瓣的情况，我们建议：1. 术前数字减影血管造影；2. 临时夹闭吻合血管并观察空肠瓣的灌注情况；3. 术中多普勒超声检查。这些技术能够在进行微血管吻合以实现下颌骨二次骨重建之前，对供区血管进行安全评估。
