Chang Y M, Santamaria E, Wei F C, Chen H C, Chan C P, Shen Y F, Hou S P
Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.
Plast Reconstr Surg. 1998 Sep;102(3):680-8. doi: 10.1097/00006534-199809030-00010.
Twelve patients with segmental mandibular defects were reconstructed with fibula osteoseptocutaneous flaps and simultaneous placement of osseointegrated implants. Decision to perform this procedure was based on the facts that all patients had benign diseases, did not require postoperative radiotherapy, were in good general and oral conditions, and were psychologically motivated. A total of 34 fixtures was inserted in the first stage. Eight patients underwent second stage surgery, which consisted of connection of the implant abutments to the fixtures and the use of palatal mucosal grafts around the implants. Final dental prostheses were fixed 1 month later in seven patients, at this time. All flaps survived after surgery, and no implant failure was observed after a mean follow-up period of 25 months. Only one fixture was not used during the subsequent stage and was left as a sleeper. Fixed dental prostheses were used in five patients and removable overlay prostheses in the other two. Chewing function was recovered between 4 and 6 weeks after the start using the definitive dental prosthesis. In contrast to previous results, we conclude that excellent results can be achieved when this combined procedure is used in carefully selected patients. In addition, it is confirmed that the fibula osteoseptocutaneous flap is a versatile, reliable composite tissue that facilitates primary placement of osseointegrated dental implants during mandible reconstruction, thus allowing full oral rehabilitation in a shorter period of time.
12例下颌骨节段性缺损患者采用腓骨骨皮瓣重建，并同期植入骨整合种植体。决定实施该手术基于以下事实：所有患者均患有良性疾病，无需术后放疗，全身及口腔状况良好，且有心理动机。第一阶段共植入34枚种植体。8例患者接受了第二阶段手术，包括将种植体基台与种植体连接，并在种植体周围使用腭黏膜移植。7例患者在此时1个月后固定了最终义齿。术后所有皮瓣均存活，平均随访25个月后未观察到种植体失败。后续阶段仅1枚种植体未使用，留作备用。5例患者使用固定义齿，另外2例使用可摘覆盖义齿。开始使用最终义齿后4至6周恢复咀嚼功能。与之前的结果相比，我们得出结论，在精心挑选的患者中采用这种联合手术可以取得优异的效果。此外，证实腓骨骨皮瓣是一种多功能、可靠的复合组织，有助于在下颌骨重建过程中一期植入骨整合牙种植体，从而在更短的时间内实现完全口腔修复。
