Shpitzer T, Neligan P, Boyd B, Gullane P, Gur E, Freeman J
Division of Plastic Surgery, University of Toronto, Ontario, Canada.
Ann Plast Surg. 1997 May;38(5):460-4. doi: 10.1097/00000637-199705000-00005.
Over a period of 3 years, 50 consecutive free fibular flaps for mandibular reconstruction were performed on 47 patients. In 38 patients (81%) a skin paddle was included with the flap to provide either mucosal lining or skin cover; in 9 patients (19%) bone alone was used. Thirty-one patients (66%) required a skin graft to close the donor defect in the leg. Donor leg morbidity and function were determined by patient questionnaire and by physical examination. Forty-one donor sites in 40 patients were available for long-term follow-up. The follow-up ranged from 4 to 39 months with an average of 17 months. Immediate postoperative infection occurred in the donor site of 1 patient (2%) and required additional surgery. There was no other immediate donor site complications when closure required skin grafting. Eleven patients (27%) had late donor site morbidity, consisting of motor weakness of the great toe in 5 patients, ankle instability and/or stiffness in 3 patients, donor site pain in 1 patient, and edema in 2 patients. All complications were graded as mild in severity by the patient and by the examiner. In this series, although most donor site defects required skin grafting, short- and long-term morbidity was minimal. After a short rehabilitation period, all patients were fully able to engage in all daily and recreational activities.
在3年的时间里，对47例患者连续实施了50例游离腓骨瓣下颌骨重建手术。38例患者（81%）的皮瓣包含皮岛，用于提供黏膜内衬或皮肤覆盖；9例患者（19%）仅使用了骨组织。31例患者（66%）需要植皮来闭合腿部的供区缺损。通过患者问卷和体格检查来确定供区腿部的发病率和功能。40例患者的41个供区可进行长期随访。随访时间为4至39个月，平均为17个月。1例患者（2%）的供区术后即刻发生感染，需要再次手术。当闭合供区需要植皮时，未出现其他即刻供区并发症。11例患者（27%）出现供区晚期发病率，包括5例患者的拇趾运动无力、3例患者的踝关节不稳定和/或僵硬、1例患者的供区疼痛以及2例患者的水肿。患者和检查者均将所有并发症的严重程度评定为轻度。在本系列研究中，尽管大多数供区缺损需要植皮，但短期和长期发病率均极低。经过短暂的康复期后，所有患者均完全能够参与所有日常和娱乐活动。
