Schusterman M A, Reece G P, Miller M J
Department of Reconstructive and Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Am J Surg. 1993 Oct;166(4):341-5. doi: 10.1016/s0002-9610(05)80328-9.
Osseous free flaps were used for reconstruction of the orbit and midface in 10 patients. The reconstruction was done at the time of tumor resection in two patients (20%) and secondarily in eight patients (80%). Nine patients (90%) had previously received radiotherapy. The flaps used were fibula (four), radial forearm (two), scapula (two), and split iliac crest (two). Flap loss occurred in one patient. Complications occurred in 2 of 10 (20%) patients. The results were classified as good in seven patients, fair in two, and poor in one. The patient classified as having a poor result was the one who sustained the flap loss; he refused further surgery. Reconstruction was directed to the maxilla in five patients, the orbit in two, and both in three. The radial forearm flap was best used for orbit-only reconstruction because of the small amount of bone required. The fibula, iliac crest, and scapula were best used for larger defects involving the maxilla. Osseointegrated dental implants were used successfully in three patients. Osseous free flaps are indicated for midface reconstruction when bony support is needed and previous irradiation prevents the use of nonvascularized grafts.
10例患者采用骨游离皮瓣重建眼眶和中面部。2例患者（20%）在肿瘤切除时进行重建，8例患者（80%）在二期进行重建。9例患者（90%）先前接受过放疗。使用的皮瓣包括腓骨（4例）、桡骨前臂（2例）、肩胛骨（2例）和劈开髂嵴（2例）。1例患者出现皮瓣丢失。10例患者中有2例（20%）发生并发症。7例患者结果为良好，2例为中等，1例为差。结果差的患者即皮瓣丢失的患者，他拒绝进一步手术。5例患者的重建针对上颌骨，2例针对眼眶，3例针对两者。桡骨前臂皮瓣因所需骨量少，最适合仅用于眼眶重建。腓骨、髂嵴和肩胛骨最适合用于涉及上颌骨的较大缺损。3例患者成功使用了骨结合牙种植体。当需要骨支撑且先前的放疗妨碍使用非血管化移植物时，骨游离皮瓣适用于中面部重建。
