髂骨复合组织瓣游离移植修复一侧上颌骨缺损

RECONSTRUCTION OF UNILATERAL MAXILLARY DEFECTS WITH FREE ILIUM OSTEO-MUSCULAR FLAP

目的 应用游离髂骨复合组织瓣 (FIOMF)即时修复一侧上颌骨切除后缺损。方法 1FIOMF的制备 ,根据缺损创面的大小 ,切取相应大小的骨肌瓣 ,注意保护血管蒂 ;2上颌骨切除按常规方法进行 ,但由于血管蒂偏短 ,故切口选择下颌下缘为好 ,将下唇中线拉开暴露上颌骨 ;3受区血管主要用颌外动脉和面前静脉或颈外静脉 ,如蒂长不够 ,可用静脉移植来解决 ;4FIOMF切取后即行修剪、固定、吻合血管 ;5腭部创面封闭可用对侧腭粘骨膜瓣 ,如缺损过大过中线 ,可用 FIOMF带皮肤封闭。早期观察指标 :1颧面部形态基本恢复 ;2无口鼻腔漏 ;3语音清晰 ;4托牙修复效果好。结果 共修复 6例 ,经 3～ 36月的随访 ,5例达到上述的观察指标 ,1例手术后因骨块坏死而失败。结论 由于 FIOMF修复一侧上颌骨缺损具有重建颧面部外形丰满 ,提供有力骨支撑 ,托牙修复效果好 ,可以进行种植体修复等优点 ,所以初步认为 :FIOMF是一侧上颌骨缺损修复的理想材料。

Objective To immediately reconstruct unilateral maxillary defects with free ilium osteo-muscular flap. Methods In six patients with maxillary malignant neoplasm, five patients underwent subtotal resection of maxilla and one patient had total maxillectomy. FIOMF was prepared, amended, shaped, and then fixed to the remained maxilla. The deep iliac circumflex artery was anastomosed with the external maxillary artery while the deep circumflex iliac vein with the external jugular vein. The palate would be completely covered with the rotated osteo-mucosal flap from the contralateral palate or the skin attached to FIOMF. Marks 1.A good zygomaticofacial appearance; 2.no naso-oral transudation; 3.articulation;4.a satisfactory rehabilition from dental prosthesis.Results Of the six patients followed up 3 to 36 months, five reached the requirements except one with osteonecrosis.Conclusions FIOMF could offer patients a good zygomaticofacial appearance and a strong support of bone, so we are of the opinion that it would be a valuable and reliable way to reconstruct maxillary defects.