游离腓骨肌皮瓣及CT血管造影技术在颌面部软硬组织缺损功能性重建中的应用

目的：评估应用游离腓骨肌皮瓣功能性重建口腔颌面部软硬组织缺损及术前增强CT血管造影检查的临床价值。方法：口腔癌患者8例，应用游离腓骨肌皮瓣一期修复下颌骨及周围软组织缺损，血管吻合采用端端吻合法，分析腓骨肌皮瓣的设计、大小、修复部位和存活情况等。术前行供瓣区增强CT断层扫描血管造影（CTA）排查腓骨肌皮瓣血管变异。结果：1例牙龈癌患者存在腓动脉与胫后动脉共干，改用其他肌皮瓣修复；余7例游离腓骨肌皮瓣全部成活，均携带1块皮岛，皮岛6cm×2cm～10．0cm×3．5cm，用于口内软组织缺损修复。术后语音功能基本正常，面部外形、功能及咬合关系良好。下肢功能在术后2周～2个月恢复正常。结论：术前CTA检查对游离腓骨肌皮瓣的供区评价具有十分重要的应用价值。游离腓骨肌皮瓣的骨量充足，具有骨膜和骨髓双重血供，抗感染能力强。可根据需要做截骨塑形从而更加准确地恢复颌骨牙槽突形态，腓骨的高度和宽度以及皮质骨的厚度也十分适合牙种植体的植入。游离腓骨瓣的皮岛还可作为术后血供的观察窗，是能够同时兼顾颌骨缺损及周围软组织缺损功能修复重建的理想方法。

Free fibula flap and computed tomographic angiography in the functional reconstruction of oral and maxillofacial hard and soft tissue defects

Assessect tne feasibility of apptlcation of free fibular flap and clinical significance of pre-operational contrast enhanced CT angiography in functional reconstruction of oral and maxillofacial hard and soft tissue defects. Method：Eight cases with mandibular and soft tissue defects received a free fibula flap using arterio- venous anastomosis anastomosis method. The relationship between fibula flap design, size, repair parts and surviv- al were analyzed. Preoperative enhanced CT angiography （CTA） examination was conducted to detect any abnor- mal blood vessels in fibula flap valve area. Result：Peroneal artery and posterior tibial artery variation was identified in one case of gums cancer, who used other muscle flap. Free fibula flap in the other 7 cases survived, which car- ried a skin island with an area ranging from 6 cm× 2 cm to 10.0 cm×3.5 cm. Postoperative facial appearance, functionality, dental occlusion and voice function was normal. Lower limb function returned to normal from 2 weeks to 4 months after surgery. Conclusion：CTA examination of the free vaseularized fibula flap in the preopera- tive evaluation of the donor site is a valuable tool. Free fibula flap of bone, periosteum and bone marrow has a dual blood supply and are highlyresistant to infection after transplantation. Personalized shaping osteotomy allowed for accurate recovery of mandibular alveolar patterns. Furthermore, the height and width of the fibula and the thick- ness of cortical bone is suitable for dental implants. Free fibula flap skin island can also be used to monitor the post-operative blood supply and is an ideal technique for mandible and soft tissue defects reconstruction as well as functional restoration.