Blackwell K E, Buchbinder D, Urken M L
Division of Head and Neck Surgery, University of California School of Medicine, Los Angeles, USA.
Arch Otolaryngol Head Neck Surg. 1996 Jun;122(6):672-8. doi: 10.1001/archotol.1996.01890180078018.
To assess the outcome of patients who are undergoing reconstruction of segmental lateral mandibular defects by using soft-tissue free flaps combined with mandibular reconstruction plates.
Retrospective case series of 15 patients who were undergoing primary reconstruction of mandibular segments posterior to the mental foramen, resulting from treatment of head and neck cancer. All patients received either preoperative or postoperative radiation therapy.
Academic tertiary care referral center.
Fourteen patients had mandibular continuity restored by using the titanium hollow screw reconstruction plate system, and 1 patient received a stainless steel mandibular reconstruction plate. Associated soft-tissue defects were repaired by using radial forearm (n = 11), rectus abdominis (n = 2), scapular and parascapular (n = 1), or lateral arm (n = 1) free flaps.
Early and delayed complications.
All 15 microvascular free tissue transfers were successful. Early complications were minor and occurred in 5 (33%) of 15 patients. One patient in whom the titanium hollow screw reconstruction plate system had been used experienced a fracture at 15 months after reconstruction. Three patients experienced delayed external plate exposure between 7 and 15 months after primary oromandibular reconstruction. Patients who experienced delayed external plate exposure required secondary reconstruction with a vascularized bone-containing free flap. The overall rate of delayed reconstructive failure was 40% in patients who were followed up for a minimum of 1 year.
For patients who are undergoing free flap reconstruction of lateral mandibulectomy defects, the technique that used soft-tissue free flaps combined with mandibular reconstruction plates has been abandoned in favor of using vascularized bone-containing free flaps or a combination of free flaps to achieve optimal long-term results.
评估采用游离软组织瓣联合下颌骨重建钢板修复下颌骨体部外侧节段性缺损患者的治疗效果。
对15例因头颈癌治疗导致颏孔后方下颌骨节段初次重建的患者进行回顾性病例系列研究。所有患者均接受了术前或术后放疗。
学术性三级医疗转诊中心。
14例患者采用钛质空心螺钉重建钢板系统恢复下颌骨连续性，1例患者接受不锈钢下颌骨重建钢板。相关软组织缺损采用桡侧前臂游离皮瓣（n = 11）、腹直肌游离皮瓣（n = 2）、肩胛及肩胛旁游离皮瓣（n = 1）或上臂外侧游离皮瓣（n = 1）修复。
早期和延迟并发症。
所有15例微血管游离组织移植均成功。早期并发症轻微，15例患者中有5例（33%）出现。1例采用钛质空心螺钉重建钢板系统的患者在重建后15个月发生骨折。3例患者在初次口颌重建后7至15个月出现延迟性外板暴露。出现延迟性外板暴露的患者需要采用带血管蒂含骨游离皮瓣进行二次重建。在至少随访1年的患者中，延迟性重建失败的总体发生率为40%。
对于接受游离皮瓣重建下颌骨外侧切除术后缺损的患者，采用游离软组织瓣联合下颌骨重建钢板的技术已被放弃，转而采用带血管蒂含骨游离皮瓣或游离皮瓣组合以获得最佳的长期效果。
