Shpitzer T, Neligan P C, Gullane P J, Freeman J E, Boyd B J, Rotstein L E, Brown D H, Irish J C, Gur E
Division of Plastic Surgery, Toronto Hospital Head and Neck Program, Ontario.
Arch Otolaryngol Head Neck Surg. 1997 Sep;123(9):939-44. doi: 10.1001/archotol.1997.01900090051007.
To evaluate the results and functional outcome associated with fibular free flap reconstruction of orofacial and mandibular defects.
We conducted a retrospective analysis of 50 consecutive fibular free flaps during a 3-year period. Forty patients were available for follow-up, which ranged from 4 to 39 months.
Academic tertiary care referral medical center.
Fifty consecutive mandibular reconstructions using the fibular free flap were performed on 47 patients. Thirty-five patients (74%) underwent primary reconstruction. Sixty-six percent of the mandibular defects were anterior or combined anterolateral types; the remainder were pure lateral defects. In 38 patients (81%), a skin paddle was included with the flap to provide either a mucosal lining or skin cover, whereas in only 9 patients (19%), bone was used alone.
Factors reflecting functional properties and processes as well as complications of the upper aerodigestive tract were evaluated clinically and radiographically.
Four flaps required reexploration as emergencies, and none were successfully salvaged (8.5% failure). Three patients underwent further free vascularized fibula transfer with 1 failure. During follow-up, swallowing was normal in 25 patients (64%), oral continence was normal or almost normal in 26 patients (67%), and speech was normal or easily intelligible in 35 patients (90%). Aesthetic results were excellent or acceptable in 37 patients (95%).
Our results reveal that the vascularized fibular free flap is very suitable with an excellent success rate for reconstructing both the composite or simple long-spanned mandibular defect. The overlying skin island is reliable and provides lining or coverage for intraoral and extraoral defects. Superior functional cosmetic results are expected in the majority of patients, while donor site morbidity is minimal.
评估腓骨游离皮瓣修复口腔颌面部及下颌骨缺损的效果及功能转归。
对3年内连续50例腓骨游离皮瓣手术进行回顾性分析。40例患者获得随访，随访时间为4至39个月。
学术性三级医疗转诊中心。
47例患者接受了连续50例使用腓骨游离皮瓣的下颌骨重建手术。35例患者（74%）接受一期重建。66%的下颌骨缺损为前部或前外侧联合型；其余为单纯外侧缺损。38例患者（81%）的皮瓣带有皮岛，用于提供黏膜内衬或皮肤覆盖，而仅9例患者（19%）单独使用骨组织。
对上呼吸道消化道反映功能特性及过程的因素以及并发症进行临床和影像学评估。
4例皮瓣需急诊再次探查，均未成功挽救（失败率8.5%）。3例患者接受了进一步的游离带血管腓骨移植，1例失败。随访期间，25例患者（64%）吞咽正常，26例患者（67%）口腔自控能力正常或接近正常，35例患者（90%）言语正常或易于理解。37例患者（95%）美学效果优良或可接受。
我们的结果显示，带血管腓骨游离皮瓣非常适合修复复合或单纯长跨度下颌骨缺损，成功率高。其上方的皮岛可靠，可为口腔内及口腔外缺损提供内衬或覆盖。大多数患者有望获得良好的功能和美容效果，而供区并发症极少。
