放射性下颌骨坏死术后缺损的游离腓骨肌皮瓣重建

Reconstruction of mandible defect in osteoradionecrosis patients with free fibula osteomyocutaneous flap

目的评价游离腓骨(肌)皮瓣重建放射性下颌骨坏死术后缺损的临床效果。方法以带肌袖和不带肌袖的游离腓骨(肌)瓣重建放射性下颌骨坏死手术切除后的骨缺损,以皮岛修复瘘周软组织缺损,记录腓骨截骨、组织瓣存活情况,供区、受区并发症,术后张口度和余留牙咬合情况,对颌面部外形和功能重建进行评价。结果随访3～16个月,4例带肌袖腓骨肌皮瓣、5例不带肌袖腓骨皮瓣重建下颌骨缺损均获成功。下颌骨截骨长度6．0～17．0 cm,切取腓骨长度8．6～17．0 cm。腓骨截成三段2例,二段5例,截成二段后折叠2例。无1例发生严重供区或受区并发症。所有病例外形恢复良好,双侧下颌角处于同一平面,无中线偏斜,开口度2．5～3．3 cm,余留牙咬合正常。义齿修复后咀嚼功能满意。结论游离腓骨(肌)皮瓣存活率高,外形和功能恢复好,适合于放射性下颌骨坏死术后颌面部软硬组织缺损的即刻重建。

Objective To explore the clinical applicating and efficacy of free fibula osteomyocutaneous flap in mandible defect reconstruction in osteoradionecrosis patients. Methods The mandible defects were reconstructed by free fibula flaps with or without muscle cuff. The soft tissue defects were repaired by skin paddles. Status of osteotomy in fibula and flap survival was recorded. The complication in recipient site and donor site, as well as mouth opening and occlusion were reviewed. Facial contour and chewing function after reconstruction were evaluated. Results Patients were followed up 3-16 months. 4 free fibula flaps with muscle cuff and 5 without muscle cuff survived well. Tbe size of mandible defects covered from 6cm to 17cm. And the harvested fibula flaps with lengtb of 8.6-17cm were cut into 3 segments in 2 cases, and 2 segments in 5 cases. Fibula flap was divided into 2 segments and overlapped in 2 cases. No serious complication was observed in recipient site and donor site. Satisfying esthetic result and normal occlusiong of heath mandible were obtained in all cases. The degree of moutb opening was 2.5-3.3cm. Fair chewing function was revealed in reconstructive region after prosthesia repaired. Conclusion Free fibula osteomyocutaneous flap is relatively ideal reconstruction material of mandible defect in osteoradionecrosis patients for its high survival rate and well esthetic results.