Horiuchi K, Hattori A, Inada I, Kamibayashi T, Sugimura M, Yajima H, Tamai S
Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan.
Microsurgery. 1995;16(7):450-4. doi: 10.1002/micr.1920160704.
Five patients underwent mandibular reconstruction using the double barrel fibular graft from 1989 to 1994. Bony defects ranged from 7 to 14 cm. In three patients, two skin flaps were taken with the fibular graft for composite reconstruction. In order to overcome the main disadvantage of the fibular graft, i.e., small circumference of the bone, a harvested fibula was osteotomized into several portions, folded into two parallel lengths, and fixed along the inferior border of the mandible and the alveolar ridge. The double barrel fibular graft provided more than 4-cm alveolar height without damaging bone viability. In Orientals, a fibula is approximately 1.5 cm thick, and using a single fibular strut for mandibular reconstruction may result in subsequent difficulty in wearing conventional dentures or osseointegrated implants. All patients acquired good mandibular contour and enough thickness of the alveolar ridge, and could wear a conventional denture and eat a solid diet. This procedure seems to be superior to the iliac bone graft for major mandibular reconstruction because of its length, the possibility of three-dimensional composite reconstruction, increased bone thickness, and minimal donor-site morbidity.
1989年至1994年间，5例患者采用双筒腓骨移植进行下颌骨重建。骨缺损范围为7至14厘米。3例患者在腓骨移植时同时采用了两个皮瓣进行复合重建。为了克服腓骨移植的主要缺点，即骨的周长较小，将取下的腓骨截成几段，折叠成两个平行的长度，并沿下颌骨下缘和牙槽嵴固定。双筒腓骨移植提供了超过4厘米的牙槽高度，且未损害骨的活力。在东方人中，腓骨厚度约为1.5厘米，使用单根腓骨支柱进行下颌骨重建可能会导致后续佩戴传统假牙或骨整合种植体困难。所有患者均获得了良好的下颌轮廓和足够的牙槽嵴厚度，能够佩戴传统假牙并进食固体食物。由于其长度、三维复合重建的可能性、增加的骨厚度以及最小的供区并发症，该手术似乎优于髂骨移植用于主要的下颌骨重建。
