应用游离腓骨-长屈肌筋膜瓣修复上颌骨缺损

A preliminary study of maxillary reconstruction using free fibula-flexor hallucis longus myofascial flap

目的 探讨应用游离腓骨 长屈肌筋膜瓣修复上颌骨缺损的可行性。方法 2 0 0 2年8月～ 2 0 0 3年 8月完成游离腓骨 长屈肌筋膜瓣行上颌骨缺损修复 9例 ,分析上颌骨缺损的原因、范围、所采用腓骨瓣的设计、受区血管、游离瓣成活情况及术后并发症。结果 本组中 4例为双侧上颌骨缺损 ,所采用的游离腓骨 长屈肌筋膜瓣中 ,腓骨长度 4 5～ 11 5cm(平均 7 7cm) ,肌筋膜瓣修复口内缺损面积为 (7～ 12 )cm× (4～ 7)cm ,腓骨的截骨段数为 1～ 3(平均 2 1) ,血管蒂长度为 8～ 11cm(平均 9 3cm) ,1例游离瓣术后出现血管危象 ,经抢救获得成活 ,长屈肌筋膜瓣全部成活 ,无一例出现供区并发症 ,患者的外形和功能在术后随访期内均得到不同程度的恢复。结论 游离腓骨 长屈肌筋膜瓣克服了传统游离腓骨复合瓣存在的缺点 ,是上颌骨缺损修复的可靠方法 ,值得进一步研究和应用。

Objective To analyze the rationale and feasibility of maxillary reconstruction using free fibula-flexor hallucis longus myofascial flap. Methods Nine consecutive cases of maxillary reconstruction using free fibula- flexor hallucis longus myofascial flaps from August of 2002 to August of 2003 were reviewed. Data concerning the operation included description of maxillary defect, design of the fibula flaps, recipient vessel and complications. Results One flap experienced venous thrombosis after operation, and the flap was salvaged after exploration. All the flaps survived completely with the overall success rate of 100%, as well as the 100% survival of all fibula-flexor hallucis longus myofascial flaps. Conclusions Maxillary reconstruction using free fibula -flexor hallucis longus myofascial flap without skin paddle is feasible and reliable.