Koshima I, Hosoda S, Inagawa K, Urushibara K, Moriguchi T
Department of Plastic and Reconstructive Surgery, Kawasaki Medical School, Kurashiki City, Okayama, Japan.
J Reconstr Microsurg. 1998 Nov;14(8):529-34. doi: 10.1055/s-2008-1040770.
Through-and-through oromandibular defects require the greatest amount of soft-tissue volume among the transfers for head and neck defects. A new method, a large anterolateral thigh flap combined with a vascularized fibula graft in a chimera fashion, has been used for two patients with wide through-and-through oromandibular defects. Among the candidates for such a large skin flap, the anterolateral thigh flap seems to be the best, for the following reasons. (1) Its pedicle, the lateral circumflex femoral system, has several major branches of equal size of anastomosis of the peroneal vessels. (2) As the majority of such patients with multiple previous surgery have lost recipient vessels near the mandible, the longest vascular pedicle is required. (3) There is no need for positional changes, and simultaneous flap elevation with the tumor resectioning is possible. (4) Use of the fibula allows for reconstruction of the entire mandible, if necessary. (5) Some of the shortcomings of individual donor sites for massive composite osteocutaneous flaps are minimized, because each component consists of two donor sites. (6) Operating time for this flap elevation is minimized, compared to that for massive composite osteocutaneous flaps, because the individual components can be obtained simultaneously by two teams.
贯通性口下颌缺损在头颈部缺损修复中需要转移的软组织量最大。一种新方法，即采用嵌合式的股前外侧大皮瓣联合带血管腓骨移植，已应用于2例广泛贯通性口下颌缺损患者。在适合采用如此大面积皮瓣的供区中，股前外侧皮瓣似乎是最佳选择，原因如下：（1）其蒂部，即旋股外侧血管系统，有几条与腓血管吻合的同等大小的主要分支。（2）由于大多数曾接受多次手术的此类患者下颌骨附近的受区血管已缺失，因此需要最长的血管蒂。（3）无需改变体位，且可在切除肿瘤的同时掀起皮瓣。（4）如有必要，使用腓骨可重建整个下颌骨。（5）由于每个组件由两个供区组成，因此可将大型复合骨皮瓣各个供区的一些缺点降至最低。（6）与大型复合骨皮瓣相比，掀起该皮瓣的手术时间最短，因为两个团队可同时获取各个组件。
