腓骨复合瓣游离移植修复下颌骨缺损

PRIMARY STUDY ON REPAIR OF MANDIBULAR DEFECT USING FREE FIBULAR COMPOSITE FLAP

目的 总结应用游离腓骨复合瓣修复下颌骨缺损的经验。方法 1999年 6月～ 2 0 0 0年 11月对5 8例应用腓骨复合瓣游离移植修复下颌骨缺损的病例作回顾性研究 ,其中男 37例 ,女 2 1例。年龄 12～ 6 5岁 ,平均4 0 .9岁。分析下颌骨缺损原因 ,分析腓骨瓣设计、受区血管、组织瓣成活情况及术后并发症的发生情况。结果 5 8例中 5 2例为肿瘤切除术后修复 ,其中 4 3例为一期修复 ,9例为二期修复。采用游离腓骨复合骨瓣的腓骨长度 4～2 1cm ,平均 11.4 cm ;腓骨的截骨为 1～ 4次数 ,平均 2 .1次 ;骨瓣带皮岛最大范围 12 cm× 8cm,最小 3.0 cm×1.5 cm。术后游离腓骨瓣的临床成功率为 96 .6 % (5 6 /5 8) ,失败 2例。受供区并发症主要为血肿、积液、创口感染和腺瘘 ,有 4例为植皮坏死和创口感染 ,发生率为 2 4 .1% ,但不影响效果。结论 游离腓骨瓣在修复下颌骨缺损中具有操作灵活 ,安全可靠 ,制备简便 ,并发症少 。

Objective To summary the clinical application of free fibular composite flaps in repair of mandibular defect. Methods Fifty eight cases of mandibular reconstruction using free fibular flaps, from June 1999 to November 2000, were reviewed, among which there were 37 cases of male and 21 cases of female, aged from 12 to 65 years old. All of the relevant data of the operation, such as the cause of the defect, design of the flaps, the blood vessels of the recipient and the complications, were included and analyzed. Results The fibular flap was 10.9 cm (4-21 cm) averagely in length and was harvested for 2.1 times (1-4 times); the average size of the skin paddle was 5.88 cm×3.13 cm. Of 58 flaps, there were 56 survived; the overall complication rate was 24.1%. Conclusion It's safe and reliable to use free fibular flap to reconstruct the mandibular defect.