Aoji K, Nishioka S, Nishikawa K, Koike S
Department of Otolaryngology, Shikoku Cancer Center Hospital, Matsuyama.
Nihon Jibiinkoka Gakkai Kaiho. 1994 Jan;97(1):41-50. doi: 10.3950/jibiinkoka.97.41.
Composite tissue defect of the mandible following the surgical resection of head and neck neoplasma or osteoradionecrosis causes functional and cosmetic disorders. Mandibular reconstruction is, therefore, necessary to obtain satisfactory results. The introduction of microvascular surgery has made it possible to transfer various types of vascularized bone grafts and this technique is considered one of the most reliable procedures for mandibular reconstruction. Recently it has been reported that an osteocutaneous scapular flap is useful for mandibular reconstruction. We have performed, over the last 2.5 years, 13 mandibular reconstructions using a vascularized osteocutaneous scapular free flap, and successful results have been achieved. The features of this flap are as follows: 1) it provides a consistent blood supply to the bone and the skin and has a constant vascular pedicle; 2) since the skin island and bone flap have separate pedicles, three-dimensional reconstructions are facilitated; 3) if needed, two skin flaps can be elevated; 4) the skin island is not so bulky; 5) the lateral border of the scapula provides highly vascularized bone of thick cortical density and osteotomies are safely performed; 6) using an angular branch based on thracodorsal artery, a bi-pedicled scapula bone can be raised and two completely vascularized bone segments can be transferred with a single pedicle. Thus, a vascularized osteocutaneous scapular flap has proven very useful for complex mandibular reconstructions.
头颈部肿瘤手术切除或放射性骨坏死导致的下颌骨复合组织缺损会引起功能和美观问题。因此，下颌骨重建对于获得满意效果是必要的。微血管外科手术的引入使得转移各种类型的带血管骨移植成为可能，并且该技术被认为是下颌骨重建最可靠的手术方法之一。最近有报道称，肩胛皮瓣对下颌骨重建有用。在过去的2.5年里，我们使用带血管的游离肩胛皮瓣进行了13例下颌骨重建，并取得了成功的结果。该皮瓣的特点如下：1）它为骨和皮肤提供持续的血液供应，并且有恒定的血管蒂；2）由于皮岛和骨瓣有独立的蒂，便于进行三维重建；3）如果需要，可以掀起两个皮瓣；4）皮岛不太臃肿；5）肩胛骨外侧缘提供皮质密度厚且血管丰富的骨，截骨术可以安全进行；6）使用基于胸背动脉的角支，可以掀起双蒂肩胛骨，并且可以用单个蒂转移两个完全血管化的骨段。因此，带血管的肩胛皮瓣已被证明对复杂的下颌骨重建非常有用。
