血管化平行折叠腓骨瓣功能性重建下颌骨肿瘤术后骨缺损

Functional reconstruction of mandibular tumor caused bone defects by vascularized double-barrel free fibular flap

目的探讨采用血管化平行折叠腓骨瓣的方法功能性重建肿瘤术后下颌骨大面积缺损,恢复外观及咀嚼功能的应用。方法收集下颌骨肿瘤扩大切除后需下颌骨区段性切除的患者13例,采用血管化平行折叠腓骨瓣重建下颌骨区段性缺损,恢复下颌骨外形及咀嚼功能。结果 13例患者均顺利完成手术,术后移植腓骨瓣成活,患者对面部外观满意,发音正常,咀嚼和咬合关系基本正常,供区无并发症。术后6个月腓骨断端间愈合良好,种植术后咬合关系稳定。肿瘤无复发。结论血管化平行折叠腓骨瓣术式改善单段腓骨重建下颌骨所致的高度不足的缺陷,减轻二次手术创伤,减少游离植骨失败率,增加大面积骨缺损自体骨移植的适应证,为后期种植奠定基础,可有效改善患者术后外观及咀嚼功能。

Objective To explore the application of vascularized double-barrel fibula flap by microsurgery in the appearance and functional reconstruction of tumor related mandibular defects. Methods Thirteen patients with mandibular defects caused by mandibular tumor expanded excision were enrolled and treated with vascularized double-barrel fibula flap microsurgery,to improve the appearance and chewing function of the mandibular. Results All 13 patients received the surgery successfully. The fibular flaps grew well after transplantation. Patients were satisfied with their facial appearance,articulation capability,as well as the chewing and occlusion function. No surgery complication was observed. Follow-up examination at 6 months after surgery showed good bone union between fibula segments and mandible. Dental implants were placed with great stability. No recurrence was found during the follow up. Conclusion Vascularized double-barrel fibular flap restores mandible morphology,alleviates surgery wound,reduces the failure rate of free graft,facilitates subsequent bone graft,and effectively improves the appearance and chewing function of the patients.