Anthony J P, Foster R D, Kaplan M J, Singer M I, Pogrel M A
Division of Plastic and Reconstructive Surgery, University of California, San Francisco 94115-1632, USA.
Ann Plast Surg. 1997 Feb;38(2):137-46. doi: 10.1097/00000637-199702000-00007.
The purpose of this study was to determine the role of the fibular free flap in reconstructing lateral segmental defects of the mandible. Over the past 5 1/2 years, 17 consecutive patients underwent reconstruction of their lateral mandible with the fibular free flap. Patients included 12 men and 5 women, the mean age was 54 years (range, 29-76 years), and the mean length of the mandibular defect was 6.3 cm (range, 2.5-9 cm). The majority of patients with tumors (54%) were treated for recurrence and 92% received radiation to the operative field. The mean operative time to perform the microsurgery and bone plating was 4 hours. Postoperative morbidity occurred in 3 patients (18%) (plate fracture, malocclusion, orocutaneous fistula). Five patients (29%) required leg donor site skin grafting. Donor site morbidity included a minor cellulitis, a transient neuropraxia, and one case of leg swelling. None required additional surgery for donor complications. Thus far, 71% of the patients have received dental rehabilitation and 35% had osseointegrated implants placed in their bone flap. Eighty-two percent of the patients achieved both good or excellent aesthetic and functional results. Sixteen patients (94%) tolerate at least a soft diet and 65% are on a regular diet. Five patients developed tumor recurrence an average of 9 months postoperatively with a mean survival of 21 months. This study demonstrates that the fibular free flap is highly reliable for reconstructing the lateral mandible in a single stage, with low overall morbidity, and provides for excellent dental and speech rehabilitation. For most patients, the fibular free flap should be considered for lateral mandibular reconstruction even in those patients with a limited life expectancy.
本研究的目的是确定游离腓骨瓣在下颌骨外侧节段性缺损重建中的作用。在过去的5年半时间里，连续17例患者接受了游离腓骨瓣重建下颌骨外侧的手术。患者包括12名男性和5名女性，平均年龄为54岁（范围29 - 76岁），下颌骨缺损的平均长度为6.3厘米（范围2.5 - 9厘米）。大多数肿瘤患者（54%）接受了复发治疗，92%的患者接受了术野放疗。进行显微手术和骨板固定的平均手术时间为4小时。3例患者（18%）出现术后并发症（钢板骨折、咬合不正、口皮瘘）。5例患者（29%）需要进行供区腿部皮肤移植。供区并发症包括轻度蜂窝织炎、短暂性神经失用症和1例腿部肿胀。均无需因供区并发症进行额外手术。迄今为止，71%的患者接受了牙齿修复，35%的患者在骨瓣中植入了骨整合种植体。82%的患者在美学和功能方面均取得了良好或优异的效果。16例患者（94%）至少能耐受软食，65%的患者能正常饮食。5例患者术后平均9个月出现肿瘤复发，平均生存期为21个月。本研究表明，游离腓骨瓣在一期重建下颌骨外侧方面高度可靠，总体发病率低，并能提供良好的牙齿和语音康复效果。对于大多数患者，即使是预期寿命有限的患者，在进行下颌骨外侧重建时也应考虑使用游离腓骨瓣。
