髂深血管蒂髂骨-腹内斜肌同蒂双岛状瓣修复下颌复合组织缺损

目的评价以髂深血管为蒂的髂骨—腹内斜肌双岛状瓣（简称同蒂双岛状瓣）修复下颌复合组织缺损的临床应用价值。方法2005年1月至2006年10月,应用同蒂双岛状瓣修复10例下颌骨复合组织缺损（包括下颌骨体部、下颌角和下颌骨升支及其周围软组织,其中有7例还包含髁突的缺损）。结果10例同蒂双岛状瓣移植均获成功,仅1例出现局部轻度感染,换药后二期愈合。术后随访3～24个月,均无肿瘤复发,颌面外形两侧基本对称,咬合关系恢复正常,且供区未见明显的并发症。结论同蒂双岛状瓣具有切口隐蔽、单一,对供区功能影响小,软硬组织复合缺损同期修复效果好等特点,是半侧下颌骨复合周围软组织大型缺损功能重建的较好方案。

Vascularized iliac crest graft with internal oblique muscle for immediate reconstruction of composite mandibular defect

Objective To evaluate the vascularized(deep circumflex iliac vessels)iliac crest graft with internal oblique muscle as a method for reconstruction of composite mandibular defect.Methods Vascularized iliac crest graft with internal oblique muscle was used to reconstruct the composite mandibular defects in 10 patients.All clinical data were analyzed retrospectively.A detailed inspection of the case-notes was undertaken to ascertain the presenting diagnosis,the surgery,the complications and the outcome.The type of mandibular defect was recorded.Results Of the 10 patients with composite mandibular defects including mandibular body,mandibular angle,mandibular ramus and the soft tissue around them,7 patients were recorded with the defects of mandibular condyles.During the follow-up period from 3 months to 24 months,primary wound healing was observed in all patients,except one patient with minor muscular necrosis.All patients were satisfied with their facial contour and mandibular shape,without tumor recurrence.Donor site problems important enough to be recorded in the notes were minimal.Conclusions The vascularized iliac crest graft with internal oblique muscle offers a useful solution for reconstruction of composite mandibular defect.There is sufficient height and depth of bone to maintain a facial contour and mandibular shape.It can be used as a routine surgical technique to reconstruct composite mandibular defect.