应用吻合血管的骨肌皮瓣修复下颌骨放射性骨坏死

Vascularized osteomyocutaneous flaps for reconstruction of the mandibular osteoradionecrosis

目的探讨下颌骨放射性骨坏死所致颌面部组织缺损的修复手段. 方法对下颌骨放射性骨坏死行死骨扩大切除术,同期用吻合血管的骨肌(皮)瓣移植修复颌面部组织缺损.共有髂骨肌皮瓣9例、髂骨肌瓣串联前臂皮瓣5例、腓骨肌皮瓣5例以及腓骨肌瓣串联前臂皮瓣1例修复20例下颌骨骨坏死. 结果临床随访1～5年,除1例髂骨肌皮瓣坏死外其余均正常成活.吻合血管的骨肌皮瓣移植成功率达95%. 结论下颌骨放射性骨坏死应行死骨扩大切除术,同期用吻合血管的骨肌(皮)瓣移植可以有效修复手术所致的颌面部组织缺损.

Objective To probe into a clinical therapy for the maxillofacial defects after extensive resection of osteoradionecrosis of the lower jaws. Methods Instantly vascularized osteomyocutaneous flaps reconstruction were operated in 20 cases of mandibular osteoradionecrosis after extensive resection of sequestrum, including 9 cases of iliac osteomyocutaneous flaps.Five cases of iliac flaps connected forearm flaps in series, 5 cases of fibular osteomyocutaneous flaps and 1 case of fibular bone flap connected forearm flap in series. Results Clinical follow-up 1~5 years, all cases were successful except one case of iliac osteomyocutaneous flap.The livabiliy of vascularised osteomyocutaneous flap was 95%. Conclusion Osteoradionecrosis of the mandible can be cure by extensive resection of sequestrum instantly vascularized osteomyocutaneous flap can availably restore the maxillofacial defects.