Free fibula flap in the reconstruction of mandible: a report of six cases

The defects secondary to surgical ablation of the mandible have far reaching consequences. Speech, respiration, mastication, deglutition and cosmesis are severely affected. Restoring these functions is a challenging task. Till the late eighties, myocutaneous flaps were the rule for mandibular reconstruction and free bone was used to restore bony continuity. In spite of the result being predictable the outcome left much to be desired. There was also a fairly regular crop of complications. Acceptable dental rehabilitation was almost non-existent. With the introduction of free flaps as a consequence of the development of the operating microscope, the field of reconstruction was revolutionized.     

外固定支架结合腓骨移位治疗胫骨长段开放性粉碎性骨折30例

目的:探讨应用外固定支架结合腓骨移位治疗胫骨长段开放性粉碎性骨折的临床效果。方法:对30例胫骨长段开放性粉碎性骨折(Gustilo3型)患者行带皮瓣腓骨移位或单纯带血管蒂腓骨移位结合外固定器治疗。结果:全部患者随访8~39个月,平均12个月。23例I期愈合,7例II期愈合。移位腓骨均在术后4~8个月与胫骨愈合,胫前软组织修复良好。所有患者膝踝关节活动正常。结论:应用外固定支架结合腓骨移位能有效修复胫骨长段开放性粉碎性骨折。     

单臂外固定支架治疗开放性胫腓骨骨折39例

目的:探讨单臂外固定支架在开放性胫腓骨骨折治疗中的应用价值。方法:对39例开放性胫腓骨骨折在急诊硬腰联合麻醉下行清创、单臂支架外固定治疗。结果:全部病例治疗效果佳,其中3例原伤口皮缘坏死、2例固定针松动、2例针道感染,经对症处理后均痊愈;随访6～15个月,患肢功能恢复满意。结论:单臂外固定支架治疗开放性胫腓骨骨折疗效肯定,值得推广使用。     

胫腓骨骨折三种固定方式的临床疗效比较

目的 比较3种固定方法 治疗胫腓骨骨折的疗效.方法 分别采用外固定支架、AO加压钢板、交锁髓内钉治疗胫腓骨骨折患者,对比其疗效.结果 随访6-24个月,平均16个月.外固定支架组与交锁髓内钉组疗效间差别有统计学意义(P<0.05),加压钢板组与交锁髓内钉组疗效间差别有统计学意义(P<0.05),外固定支架组与加压钢板组疗效间差别无统计学意义(P>0.05).交锁髓内钉组和其余两组并发症发生率间差别有统计学意义(P<0.05).结论 交锁髓内钉可广泛应用于闭合性胫腓骨复杂骨折,且优于AO钢板及外固定支架,术后骨折愈合较为理想.AO钢板应慎用于胫骨中下1/3段复杂闭合性骨折,外固定支架对于开放性骨折是上述方法 的补充.     

Agenesie der Tibia,Fibulaverdoppelung und spiegelbildliche Polydaktylie (Diplopodie) bei Mutter und Kind

Zusammenfassung Agenesie der Tibia mit beidseitiger Verdoppelung der Fibula und spiegelbildlicher Anordnung von 2×4 dreigliedrigen Zehen wird bei dem Kind einer Frau festgestellt, welche die gleiche Anomalie auf einer Seite, eine prähallukale Polydaktylie bei erhaltener Tibia auf der anderen Seite aufweist. Ein gleicher Fall ist nicht bekannt. Ähnliche Fälle von präaxialer Polydaktylie aus der Literatur mit oder ohne Tibiadefekt, mit oder ohne eine analoge Anomalie der oberen Extremitäten (Doppelung und Triphalangie des Daumens) werden zusammengestellt. Aus ihnen werden 4 Mißbildungstypen gebildet, die durch dominante Gene verusacht zu sein scheinen.

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Agenesia of the tibia, duplication of the fibula and mirror foot in mother and child

Bilateral agenesia of the tibia, bilateral duplication of the fibula and a mirror foot are studied in a child. His mother exhibits the same malformation on one side of the body, prehallucal polydactyly with the tibia, intact on the other side. This case seems to be unique. Similar cases of preaxial polydactyly with or without a defect of the tibia and with or without an analogous anomaly of the upper extremities (duplication and hyperphalangy of the thumb) taken from the literature are classified. 4 different types which could be due to dominant genes are proposed.

Auszugsweise vorgetragen anläßlich der Tagung der Gesellschaft für Anthropologie und Humangenetik, Göttingen 1971.     

部分切除腓骨对踝关节稳定的影响

对8例新鲜尸体的踝关节在完整胫腓骨与腓骨部分切除时的外踝上下和侧向位移变化进行了测试与分析,结果显示腓骨部分切除后,外踝无论是上下位移还是侧向位移都显著增加,表明完整的腓骨对维持踝关节的稳定具有相当大作用。     

Temporal and spatial activity in mirror segments of mature dog fibulae

This investigation was undertaken to determine if the metabolic activity of homotypic segments of dog fibulae could be reliably compared in a thirty day period. Activities analyzed were: cumulative formation, porosity, resorption and apposition. Analyses were performed on contiguous tissue sections using microradiographic and tetracycline techniques. Spatial arrangements of the various activities were analyzed by constructing three dimensional models. The data permitted the following conclusions: 1) The mean differences between dog homotypic fibular segments are much smaller than the mean differences between heterotypic sites. 2) The use of homotypic fibular sites as valid controls should be limited to investigations in which the differences worth detecting are at least greater than 4% (apposition), 2% (resorption), 0.6% (porosity), and 2% (cumulative formation). 3) Of the four parameters measured, porosity was the most constant, showing no significant differences between mirror segments. 4) Lag correlations emphasize the importance of utilizing all available contiguous sections in a given specimen. 5) Physiologic resorption was not exclusive in old bone. 6) The sites of metabolic activity were predominantly found among specific active osteons which were primarily distributed peripherally in a strikingly similar pattern between mirror segments.These studies were supported by the United States Public Health Service Grant 5 RO1 AM 14063, Department of Health, Education and Welfare. Presented at the Orthopaedic Research Society Meeting, March 6–11, 1971, San Francisco, California.     

Free fibular flaps in children: morbidity of the donor site and pitfalls to avoid

INTRODUCTION: We report a case of donor site morbidity late after harvesting a free fibular flap for reconstruction of the mandibular symphsis. CASE REPORT: An 8-year-old boy presented a valgus deformity of the ankle 4 years harvesting of a vascularized fibular graft for mandibular reconstruction. The deformation was repaired with a tibial bone slit and pin fixation. The biomechanical result was very satisfactory, allowing normal gait. DISCUSSION: We recall the rules for fibular flap harvesting needed to prevent deformation of the donor site in children aged less than 9 years.     

吻合血管的腓骨瓣移植一期重建双侧下颌骨

目的探讨下颌骨巨大肿瘤截骨切除后应用游离腓骨复合组织瓣一期重建双侧下颌骨方法和疗效。方法2000年7月至2002年10月,分别对波及双侧下颌骨的4例巨大成釉细胞瘤、2例牙龈癌施行截骨切除,手术造成跨中线的双侧下颌骨巨大缺损。根据下颌骨缺损的特点,以腓动静脉为血管蒂切取腓骨肌(皮)瓣,经截骨塑形后,用微形钛板将移植骨与双侧下颌骨残端坚固内固定,腓动、静脉与颈部小血管吻合,形成血管化腓骨复合组织瓣一期重建双侧下颌骨。结果6例移植腓骨复合组织瓣全部成活。随访6个月-2年,面下部外形恢复良好,移植腓骨与上颌骨相对位置正常,接受活动义齿修复后咬合关系和咀嚼功能均较满意。结论腓骨复合组织瓣节段性的骨膜供血和骨髓滋养动脉的双重供血特点十分适合塑造成下颌骨的弓状形态,是修复下颌骨巨大肿瘤导致的跨中线双侧下颌骨巨大缺损的理想材料。