Vinzenz K G, Holle J, Würinger E, Kulenkampff K J
Department of Maxillo-Facial Surgery, Evangelisches Krankenhaus Wien-Währing, Austria.
J Craniomaxillofac Surg. 1996 Aug;24(4):214-23. doi: 10.1016/s1010-5182(96)80004-7.
Nowadays, in congenital or acquired large oro-maxillofacial defects, microsurgical reconstruction is mainly performed by revascularized osseous, osteocutaneous, or osteomyocutaneous distant flaps. The aims of reconstruction include not only restoration of stability and aesthetic contour, but also the restoration of a functioning 'chewing organ'. In addition to bulkiness of the flaps, the stepwise surgical procedure (microvascular reconstruction, osseointegration of implants, secondary correction of flaps including preprosthetic surgery, etc.) prevents physiological oral function for a long time, and has some implications for creating an alternative method of microsurgical reconstruction with newly designed flaps. For reconstruction in maxillary and midface defects we prefer the use of the scapula flap. Since modern diagnostic methods allow comprehensive planning and defining of all relevant anatomical and functional factors in advance, the 'simultaneous' microvascular reconstruction by prefabricated scapula flaps has become possible and offers some advantages. The tissue prefabrication results in osseointegrated implants and thin mucosal linings with stable peri-implant soft tissue conditions at the time of microsurgical reconstruction. Postoperatively, after immediate dental restoration full oral function is attained. The 'simultaneous' reconstruction improves the psychosocial situation of the patient considerably.
如今，在先天性或后天性的大型口腔颌面部缺损中，显微外科重建主要通过带血管蒂的骨、骨皮或骨肌皮游离皮瓣来进行。重建的目的不仅包括恢复稳定性和美学轮廓，还包括恢复一个有功能的“咀嚼器官”。除了皮瓣体积较大外，逐步的手术过程（微血管重建、种植体骨整合、包括修复前手术等对皮瓣的二期矫正）会在很长一段时间内妨碍生理口腔功能，这对于设计新的皮瓣来创造一种替代的显微外科重建方法具有一定意义。对于上颌和中面部缺损的重建，我们更倾向于使用肩胛皮瓣。由于现代诊断方法能够提前全面规划并确定所有相关的解剖和功能因素，通过预制肩胛皮瓣进行“同步”微血管重建已成为可能，并具有一些优势。组织预制可在显微外科重建时实现种植体骨整合以及形成薄的黏膜内衬，且种植体周围软组织条件稳定。术后，在即刻进行牙齿修复后即可获得完整的口腔功能。“同步”重建极大地改善了患者的心理社会状况。
