重建下颌骨的腓骨肌瓣移植术后血供的监测

Monitoring of Blood Supply to Free Fibula Flap Used to Reconstruct Mandibular Defects

目的：探讨腓骨肌瓣重建下颌骨移植术后组织瓣血供情况的监测方法。方法：６例腓骨瓣移植修复下颌骨缺损的病例，术后其中２例利用腓骨肌瓣所带的皮瓣观察，另４例应用超声多普勒听诊仪检测移植骨瓣的腓动脉血流而间接观察。结果：６例腓骨瓣全部存活。用以观察的皮瓣色泽良好；超声多普勒听诊结果显示，４例移植瓣动脉的血流均通畅，尽管其中１例植骨区感染，观察结果与实际情况仍相符合。结论：腓骨瓣的皮窗和超声多普勒检测方法能准确反映移植骨瓣的血供。

Objective: To evaluate the methods to monitor the blood supply to free fibula flap that was used to reconstruct mandibular defects. Methods: Six cases with mandibular defects were reconstructed with free fibula flaps. To monitor the blood supply to the transplant, 'buoy flap' of fibular osteomyocutaneous flaps were used for two cases, and ultrasound stethoscope doppler was used for other four cases. Results: All the revascularized flaps survived with a success rate of 100 %. After operation, skin color of two 'buoy flaps'was normal. Ultrasound stethoscope doppler readings of the other four cases showed distinctive auditory signals, although one case infected. Conclusion: Blood supply to the free fibula flap that was used to reconstruct mandibular defects could be identified from skin color of 'buoy flap'or from reading of ultrasound stethoscope doppler, with reliable results.