折叠腓骨瓣一期修复下颌骨放射性骨坏死

Simultaneous reconstruction of postoperative defects of mandibular osteoradionecrosis with double barrel fibula osteocutaneous flap

目的探讨采用折叠腓骨复合组织瓣一期修复下颌骨放射性骨坏死术后复合组织缺损的方法,并观察其临床疗效。方法2004年5月至2005年4月,中山大学附属口腔医院口腔颌面外科采用折叠腓骨皮瓣一期修复下颌骨放射性骨坏死的临床病例共5例。制备腓骨皮瓣,在保持骨膜连续性的情况下,将腓骨截骨后自身折叠成“双管”型腓骨皮瓣,修复受区缺损。结果5例腓骨皮瓣均成活。术后随访平均8个月,无严重并发症,术后颜面部基本对称,外形满意。复查X线片示腓骨皮瓣与健侧下颌骨骨结合良好,重建下颌骨高度满意,为义齿修复创造了良好的牙槽骨条件。结果折叠腓骨复合组织瓣一期修复下颌骨放射性骨坏死的成功率高,有效修复了下颌骨及软组织复合缺损,临床疗效满意,值得临床推广应用。

Objective To evaluate the clinical outcome of simultaneous reconstruction of postoperative defects of mandibular osteoradioncerosis with double barrel fibula osteocutaneous flap. Methods From May 2004 to April 2005, five patients suffering from mandibular osteoradionecrosis after radiotherapy of nasophar3,ngeal carcinoma underwent mandibulectomy and simultaneous microsurgical reconstruction with double barrel fibula osteocutaneous flap in our hospital. After the mandibulectomy, the fibula osteocutaneous flaps were harvested. The fibula was osteotmized into several portions, folded into two parallel lengths, and then fixed along the inferior border of the mandible. The ＂double barrel＂ fibula provided 2.6 - 3. Ocm alveolar height. The time of the whole surgery, including mandihulectomy and reconstruction lasted from 4 to 7.5 hours. Results All vascularized fibula osteocutaneous flaps transplanted were successful with good primar3, bone healing. There were no serious postoperative complications. The patients were followed up from 4 to 14 months, averaged 8 months. During the follow-up period all patients acquired good mandibular symmetr3, and the facial contour was satisfactory. Postoperative X-ray showed the height of the alveolar ridge was enough for implant prosthetic rehabilitation. Conclusion Double barrel fibula osteocutaneous flap provides an ideal, suitable and effective surgical method to simuhaneousN reconstruct the postoperative defects of mandibular osteoradionecrosis after mandibulectomy.