血管化平行折叠腓骨瓣重建下颌骨肿瘤术后骨缺损

Double barrel vascularized free fibular flap for reconstruction of mandibular defects after tumor ablation

目的：探讨应用血管化平行折叠腓骨瓣重建下颌骨肿瘤术后骨缺损的临床效果。方法 ：采用血管化游离平行折叠腓骨肌皮瓣修复重建下颌骨肿瘤术后缺损9例,男6例,女3例,年龄17-61岁,平均37岁;其中,折叠修复5例,部分折叠修复4例,下颌支缺损仅行单层腓骨修复。结果：9例患者术后移植腓骨肌皮瓣均成活,颌面部及腿部术区创口一期愈合,颌面部外形满意,无开口受限,语音清晰,吞咽功能基本正常,下肢腓骨供区无明显并发症。术后3例行二期种植义齿修复,4例因经济原因行可摘义齿修复,2例暂未行义齿修复。已行修复病例义齿与余留牙咬合关系基本正常,咀嚼功能恢复良好。术后6个月复查,全景片提示移植腓骨愈合良好,移植骨高度较正常下颌骨略低。所有病例均随访1-3 a,均无复发。所有患者自我评估对颌面部外形满意。结论：应用血管化平行折叠腓骨瓣技术重建下颌骨缺损,克服了传统腓骨瓣修复后骨质高度不足的缺点,为义齿修复提供足够的骨量,能获得良好的颌面部美学形态和功能效果。

PURPOSE： To explore the clinical value of double barrel vascularized free fibular flap for reconstruction of mandibular defects after tumor ablation. METHODS： A total of 9 patients who underwent reconstruction of mandibular defects with double barrel vascularized free fibular flap were included in the study. Among them, six patients were male and 3 were female, the ages of the patients ranged from 17 to 61 years（37 years on average）. Double-barrel vascularised fibular graft was used in 5 cases and partial double-barrel fibular graft in 4 cases. Mandibular ramus defects were reconstructed with single-strut fibula. RESULTS： The fibular graft survived in all patients, the surgical incision in the oral and maxillofacial region healed primarily, and the fibular flap donor sites healed well without complications in the donor site of the lower extremities. The contours of the face were satisfied and no mouth opening limitation. The speeches were comprehensible and swallowing functions were good. Three patients accepted secondary implantation postoperatively,four patients accepted conventional removable dentures for economical reasons and 2 patients had not received any denture till now. Occlusions in patients who received denture rehabilitation were normal and the function of chewing recovered well. Panoramic radiograph 6 months after operation revealed that the grafted fibula healed well, the height of graft bone was slightly lower than normal mandible. All cases were followed up for 1 to 3 years without recurrence. All patients were satisfied with the facial appearance by self assessment. CONCLUSIONS： The technique of double barrel vascularized free fibular flap for reconstruction of mandibular defects overcame the shortage of traditional fibular flap with insufficient bone height, and provided enough bone for denture fabrication and dental implantation. Good aesthetic and functional outcome can be achieved.