血管化腓骨肌瓣移植重建下颌骨缺损的外科改良

Modifications of mandibular reconstruction with free fibular flap

目的:对重建下颌骨缺损的血管化腓骨肌瓣制备和塑形方法进行外科改良。方法:(1)非驱血状态下于大腿安放电子止血带加压后直接进行腓骨组织瓣制备;(2)暴露腓骨后,在待取腓骨的上下端各截除小段骨再实施腓骨的带血管制备;(3)对腓骨施行阶梯状截骨塑形。结果:7例腓骨瓣制备和术后出血(渗血)少,制备时间缩短。术后均一期成活,未发生感染或其他并发症。骨段固定稳固,下颌轮廓和外形良好。结论:(1)非驱血制备腓骨瓣不增加出血机会,反而减少出血机会,简化手术操作;(2)在待取腓骨的上下端截除小段骨可以使待取腓骨段充分游离,便于带血管制备和减少损伤血管的机会;(3)阶梯形截骨塑形,既增加了骨断面的接触面积和稳定性,又避免了楔形切骨骨量的丧失。

Objective： To present a modified method for harvesting and shaping fibular flap in reconstruction of mandibular defect. Methods： Fibula flap harvesting was performed under non-blood-evacuation of the donor limb and two gaps were made at the upper and lower ends of the fibular flap during the flap harvesting. Step-like osteotomy was performed to obtain 3 segments（ each segment was 3 - 5 cm in length） of fibular bone. The shaping was achieved by fitting the bone segments together based on the natural contour of the mandible. The modified operation was conducted in 7 patients for mandibular reconstruction. Results： The method was successfully used in all patients with less bleeding during the flap harvesting and after reconstruction. The bone segments were rigidly fixed with good bony consolidation and contour. No complications occurred. Conclusion： The modified fibular flap harvesting method is feasible in mandible reconstruction.