游离组织瓣移植同期修复下颌骨放射性骨坏死术后缺损

A Review of 11 Cases of Immediate Free Flap Transfer for Treating the Advanced Osteoradionecrosis of Mandible

目的 探讨游离组织瓣移植在晚期下颌骨放射性骨坏死治疗中的可靠性和应用价值。方法 采用游离组织瓣移植同期修复 11例晚期下颌骨放射性骨坏死术后缺损的患者。分析原发肿瘤的部位和类型、放疗剂量、缺损的范围、所采用游离瓣的设计、受区血管的选择、游离瓣的成活情况及术后并发症的发生情况。结果 11例患者共采用 15块游离组织瓣修复缺损 ,包括 12块游离腓骨瓣、2块腹直肌皮瓣和 1块前臂皮瓣。 1例患者采用 3块游离瓣修复 (腓骨瓣、腹直肌瓣和前臂瓣 ) ,2例患者采用 2块游离瓣修复 (腓骨瓣和腓骨瓣 ,腓骨瓣和腹直肌瓣 ) ,余 9例患者各采用 1块游离瓣修复。全部游离瓣均获得成活 ,无 1例出现血管危象及组织瓣的全部或部分坏死。全部患者术后放射性骨坏死的症状均完全缓解 ,外形和功能也得到了不同程度的恢复 ,随访期间未见有肿瘤和放射性骨坏死复发。结论 对于晚期的下颌骨放射性骨坏死 ,采用病灶切除同期游离组织瓣移植是有效可行的方法 ,游离腓骨瓣是修复下颌骨缺损的首选。

Objective To assess the effectiveness and reliability of free flap transfer for treating the advanced osteoradionecrosis(ORN)of mandible.Methods Eleven cases of free flap transfer for treating the advanced ORN of mandible from October 1999 to February 2003 were reviewed. Data concerning the operation included site, stage and histology of primary tumor, dosage of radiotherapy, defect description, design of free flap, recipient vessel, free flap survival and complications.Results There were 8 males and 3 females, with age ranged 29-65 years old. Fifteen free flaps were used for reconstructing the defects, 12 were fibula flap, 2 were rectus abdominis myocutaneous flap, and 1 was radial forearm flap. All the free flaps survived completely without partial or total necrosis. The complication rate was 36.4%. All patients had complete resolution of ORN symptoms. No evidence of ORN recurrence was observed in any patient.Conclusion Free flap transfer provides a reliable and effective means for treating the advanced ORN of mandible. Free fibula flap is the workhorse flap for reconstruction of mandible.