自体游离腓骨肌皮岛修复下颌骨大面积软硬组织缺损的临床应用

Clinical application of autologous fibula myocutaneous island flap in the treatment of huge mandibular hard and soft tissue defect

目的：研究下颌骨肿瘤及外伤致大面积软硬组织缺损，并行自体游离腓骨肌皮岛重建下颌骨及修复口腔内缺损的软组织的临床应用。方法：2011年3月～2014年3月15例下颌骨肿瘤及外伤后大面积软硬组织缺损的患者，应用显微吻合微血管的方法，移植游离腓骨，修复大面积缺损的下颌骨及口腔内的软组织。术后1、3、6个月观察修复效果，并发症发生及术后下颌骨的恢复情况。结果：15例患者均移植腓骨瓣成活，以上15例患者术后随访1年，面部及下颌外形、咬合情况良好，术区踝关节未出现不稳定情况，语言、咀嚼、吞咽功能恢复正常，供区愈合良好，行走正常。但2例患者术后1个月出现跑步时，下肢疼痛及平衡困难症状，6个月后逐渐改善并恢复相关功能。15例患者术后6个月行全口义齿修复治疗，修复效果可，恢复良好咬合功能及咀嚼功能，未出现颞颌关节紊乱情况。结论：应用自体游离腓骨肌皮岛修复口腔颌面部软硬组织及恢复患者面部外观及口腔重要生理功能方面都可取得满意临床效果。

objective To investigate the hard and soft tissue defect caused by mandibular tumor and trauma, and to review the clinical application of autologous fibula free flap in the reconstruction of mandible and oral soft tissue defect. Methods From March 2011 to March 2013, 15 patients who had large hard and soft tissue defect followed by mandibular tumor or trauma were underwent reconstruction of mandibular and oral tissue defect using microscopic anastomosis and Free fibula transplantation. Restorative effects, complication and recover condition of mandible were reviewed postoperative 1, 3, and 6 months. Results The all flaps were alive after one year follow-up, the facial counter and mandibular counter were good, the ankle joint in the operation site was normal, speech, mastication, and the deglutition function recovered normally. However, two patients experienced pain on lower limbs while running and difficulty in body balance one month post-operatively, and recovered gradually six month post-operatively. 15 patients had complete denture restoration after six months operation, good occlusion and mastication functions were restored without TMJ disorders. Conclusion Autologous myocutaneous fibula free flap can produce satisfactory results in the repair of maxillofacial soft and hard tissue and restoration of vital physiological function of oral cavity.