Holle J, Vinzenz K, Würinger E, Kulenkampff K J, Saidi M
Department for Plastic and Reconstructive Surgery, Wilhelminenspital, Vienna, Austria.
Plast Reconstr Surg. 1996 Sep;98(3):542-52. doi: 10.1097/00006534-199609000-00031.
A concept for improving the precision of reconstruction of the maxilla in terms of form and function, including gnathologic, functional, and prosthetic aspects, is presented with a prefabricated combined scapula flap. In four cases, a bony flap from the lateral border of the scapula with osseointegrated titanium implants, covered with skin grafts and encapsulated with a Goretex sheet to create a stable soft-tissue coverage, was performed. Three months later, the prefabricated combined scapula flap was harvested and transferred to reconstruct a maxillary bony and soft-tissue defect in the face using microsurgical vascular anastomoses to the facial vessels. One flap was lost because of vascular thrombosis and was repeated successfully 1 year later. In each of the four cases, full dental rehabilitation and marked improvement of the facial contour was achieved in a single surgical intervention of the face. For this purpose, new radiodiagnostic methods for precise correlation between the maxillofacial defect and the donor area were use. With this new concept, an organ-specific reconstruction of soft-and bony-tissue defects of the alveolar ridge and the hard palate, with a pseudogingiva and teeth, is possible in an optimal way.
本文介绍了一种利用预制组合肩胛皮瓣提高上颌骨形态和功能重建精度的概念，包括颌学、功能和修复方面。在4例手术中，取自肩胛骨外侧缘的骨瓣植入骨整合钛种植体，覆盖皮肤移植片并用戈尔特斯片包裹以形成稳定的软组织覆盖。3个月后，切取预制组合肩胛皮瓣，通过与面部血管进行显微外科血管吻合，转移至面部重建上颌骨的骨和软组织缺损。1例皮瓣因血管血栓形成而失败，1年后再次手术成功。4例患者均在一次面部手术中实现了全牙列修复并显著改善了面部轮廓。为此，采用了新的放射诊断方法以精确关联颌面部缺损与供区。通过这一新概念，可以以最佳方式对牙槽嵴和硬腭的软组织和骨组织缺损进行器官特异性重建，并带有假牙龈和牙齿。
