Upper eyelid reconstruction with a hard palate mucosa-lined bipedicled myocutaneous flap

The upper eyelid is very difficult to reconstruct because smooth opening and closure of the eyelid must be maintained. A patient is presented in whom a hard palate mucosa-lined bipedicled myocutaneous flap containing innervated orbicularis oculi was used to successfully reconstruct a subtotal upper eyelid defect. Good functional and aesthetic results were achieved. This method may be a good alternative for reconstruction of large upper eyelid defects.     

游离腓骨复合瓣下颌骨重建时供区侧下肢的选择

目的探讨下颌骨重建采用游离腓骨复合瓣时供区侧下肢的选择原则。方法回顾分析1999年5月至2007年4月期间完成的602例游离腓骨复合瓣下颌骨重建的病例，依据血管蒂和皮岛的位置将腓骨瓣的就位方式分成4类（Ⅰ～Ⅳ类）。结果602例中Ⅰ类424例、Ⅱ类71例、Ⅲ类63例、Ⅳ类44例。18例腓骨瓣术后出现血管危象，8例经抢救获得成功，腓骨瓣的临床成功率为98．3％。结论术前评估下颌骨缺损的范围、受区血管的位置及软组织缺损的部位和范围，有助于正确设计腓骨瓣就位时血管蒂和皮岛的位置，从而选择合适的供区侧下肢。     

Maxillary reconstruction using rectus abdominis free flap and bone grafts

We did total maxillectomies for cancer in 22 patients and reconstructed the face with rectus abdominis free flaps and bone grafts. The functional and aesthetic results have been satisfactory. The use of rectus abdominis free flap with nonvascularised bone grafts is a useful technique after excision of the maxilla and orbital floor. It permits a reliable, safe, one-stage reconstruction of complex three-dimensional anatomy with stable functional and aesthetic results.     

Functional outcomes and patient satisfaction after vascularized osteocutaneous scapula flap reconstruction of the mandible in patients with benign or cancerous tumours

Pre- and postoperative longitudinal assessment of oral functions including masticatory force, masticatory ability with solids, speech intelligibility, and subjective satisfaction was conducted for patients who underwent vascularized osteocutaneous scapula flap reconstruction after mandibulectomy. Postoperative changes in oral function and patient satisfaction were examined in relation to tumour type (i.e., cancerous vs. benign). A change in masticatory force was associated with a reduction in the number of occlusal support zones after surgery and clearly differed by tumour type. Despite all patients showing reduced masticatory force postoperatively, all were satisfied with the improvements in eating and chewing, which were greater in patients with benign tumours than in those with cancerous tumours. Although both groups of patients expressed satisfaction with the aesthetic appearance after surgery, patients with cancerous tumours were more satisfied. However, both groups showed decreased speech intelligibility scores and lower satisfaction with speech after surgery. Preoperative support in the form of reassurance and helping to alleviate anxiety about postoperative appearance would be beneficial for all patients, with additional support provided based on the specific tumour type.     

Successful free osteocutaneous scapular flap transfer for mandibular reconstruction in a 93-year-old patient

With the extension of the average life span and the development of surgical technique, anesthesia, and pre- and postoperative management, operations for elderly patients have become more widely accepted. In the field of plastic surgery, free-flap transfers using microvascular techniques have become a common surgical procedure in reconstruction of the head and neck region after surgical removal of a cancer. There have been several reports of free-flap transfer in patients older than 90 years, but the authors know of no reports of free osteocutaneous flap transfer for mandibular reconstruction, which is a very invasive free-flap surgery, for such patients. The mandible plays a significant role in various kinds of dynamic functions, such as mastication, deglutition, and articulation. Disorder of these functions causes a deterioration in the patient's quality of life. The authors have performed a mandibular reconstruction using an osteocutaneous scapular free flap after resection of a gingival cancer invading the mandibular bone in a 93-year-old Japanese woman. In our case, an osteocutaneous scapular free flap, which permits the patient rapid rehabilitation of the lower leg, is thought to be a good choice because it allows the patient to get out of bed as quickly as possible in the postoperative period to minimize additional complications.     

The radial forearm flap as a carrier for the osteocutaneous fibula graft in mandibular reconstruction

According to the concept of a free flap carrier we transferred an osteocutaneous fibula graft after microanastomosis to a pedicled radial forearm flap for reconstruction of the lower face in a patient with a total occlusion of the left and a subtotal occlusion of the right common carotid artery. The fibula was osteotomized in three segments to form the new mandible, and the skin paddle was placed extraorally. An external fixation device was connected to the radial bone, and a halo frame was fixed to the skull, and the forearm was thus stabilized rigidly in a suitable position. After 2 weeks, serial occlusion of the pedicle was begun twice daily. Blood flow and haemoglobin oxygenation of the skin paddle were measured by laser Doppler flowmetry and photometry. At the 14th day of ischaemic preconditioning, the flap could tolerate 3h of occlusion. Then the carrier vessels and the forearm flap were excised. The flap survived completely based on neovascularization from the recipient site.     

The bipedicled lip flap for reconstruction of the vermilion border in the patient with a severe perioral burn

Reconstruction of the severely burned lip may require both reconstitution of the tissue bulk and an increase in size of the vermilion. We present two patients in whom a bipedicled lip flap was used to transpose both bulk and vermilion from the relatively normal donor lip to the atrophic burned lip.     

腓骨肌皮复合组织瓣的临床手术解剖研究

了解腓骨肌皮复合组织瓣血供特点,手术实施种植义齿的可行性,为其临床应用提供临床手术解剖 基础。方法对１０例病人切取腓骨肌皮复合组织瓣以供修复下骨及周围软组织,观察腓骨肌皮复合组织瓣的（１）血供特点;（２）手术操作要点;（３）手术并发症;（４）腓骨与种植义齿的关系。     

游离腓骨肌皮复合组织瓣一期修复下颌骨及软组织缺损

目的寻找一种既能满足下颌骨及软组织复合缺损重建需要，又不影响供区功能的新的修复材料。方法对１０例各种原因所致的下颌骨及周围软组织缺损患者，采用游离腓骨肌皮复合组织瓣进行修复重建。所切取的腓骨平均长度９１ｃｍ，肌皮瓣平均大小为４５ｃｍ×６２ｃｍ。结果术后２周经９９ｍＴｃＯ－４骨扫描等证实，９例（９／１０）骨肌皮瓣成活，患者下颌功能与外形良好，行走无障碍。结论腓骨肌皮复合组织瓣骨量充足，骨质坚硬，腓骨血供具二重性，利于塑形，可以用作下颌骨及软组织缺损的修复。     

Composite fronto-orbital reconstruction using a subscapular chimeric flap

Composite defects of the fronto-orbital region represent a reconstructive challenge. Total autogenous reconstruction requires a thin pliable skin flap along with a bony component that can be osteotomized predictably. The thoracodorsal artery perforator/scapular bone chimeric flap provides a reliable single-stage method to cover difficult composite forehead defects where local options are unsuitable or have been exhausted. We present a patient with a traumatic fronto-orbital defect that has been successfully reconstructed using this flap. The report of this case illustrates well the versatility of the subscapular system as a donor site for difficult composite posttraumatic defects where tissue components need to be inset in a complex three-dimensional fashion.     

游离排骨肌皮复合组织瓣一期修复下颌骨及软组织缺损

寻找一种既能满足下颌骨下软组织复合缺损重建需要，又不影响供区功能的新的修复材料。方法对１０例各种原因所致的下颌骨及周围软组织员虱，采用游离腓骨肌皮复合组织瓣进行修复建建。     

Management of class IV skull burns using the bipedicled superficial temporal artery scalp flap

Calvarial burns are extremely rare and pose a difficult challenge for both the burn and reconstructive surgeon. Reconstruction of these injuries is dependent on the depth of invasion and the amount of tissue loss. Fourth-degree burns include damage to the calvarium and the underlying dura and or cerebrum. Historically, these wounds have been treated conservatively. Two cases of electrical fourth-degree calvarial burns with large soft tissue defects as well as loss of calvarium and dura with cerebral herniation are presented. Each patient presented to Shriners Burn Hospital in a delayed fashion with infected wounds necessitating immediate intervention. Both patients were debrided and covered with a bipedicled superficial temporal artery scalp flap. The donor sites of each flap, as well as the remaining areas, were skin grafted. This flap provides immediate vascularized coverage in wounds that were unable to be treated conservatively. In the face of sepsis and other severe injuries where more complicated flaps are risky, this flap provides a reasonable and reliable method of calvarial coverage.     

Maxillary myxoma: surgical treatment and reconstruction with buccal fat pad flap: a case report

Myxoma is a benign tumor that arises from mesenchymal tissue and is found less commonly in the bone than in soft tissue. The majority of bony myxomas occur in the jaws. When compared with other odontogenic tumors, myxoma of the jaws is a rare entity. Numerous types of treatment have been used for these tumors including simple curettage, enucleation, curettage with peripheral ostectomy, and en bloc resection with or without immediate reconstruction. The buccal fat pad (BFP) is a lobulated mass of fatty tissue in the oromaxillofacial region, which has long been a source of grafts in facial augmentation. A case of an odontogenic myxoma in the left maxillary molar area of a 34-year-old female that was treated by curettage and peripheral ostectomy is presented. The surgical defect was successfully repaired with a pedicled BFP flap.