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.     

计算机辅助游离腓骨下颌骨重建的术后效果评估

目的 建立一种标准化、可重复、简易的数字化评估方法,精确评估计算机辅助游离腓骨下颌骨重建术后效果.方法 通过对20例因肿瘤致下颌骨缺损后行计算机辅助游离腓骨下颌骨重建手术病例的回顾性分析,在Mimics Research 21.0及3-matic Research 13.0软件辅助下对重建术前与术后冠状向、矢状向与轴向...     

Mandibular reconstruction with free fibula flaps in the elderly: a retrospective evaluation

The purpose of this study was to evaluate surgical outcomes in elderly patients who had undergone free fibula flap transfer for malignant head and neck tumours. A retrospective chart review was performed to identify patients who had undergone free fibula flap transfer for mandibular reconstruction after malignant tumour resection at Jichi Medical University Hospital between May 2009 and April 2015. Enrolled patients were divided into an elderly group (≥80 years old) and a younger group (<80 years old). Seventeen patients met the inclusion criteria and were included in the elderly group. Age at surgery ranged from 80 to 92 years. Thirteen patients (76.5%) experienced postoperative complications. Surgical site complications occurred in seven patients. The success rate of free fibula flap transfer was 100%. Systemic complications occurred in nine patients, most commonly delirium (n = 6). No perioperative mortality was encountered. The overall 1-year survival rate was 94.1% (16/17). No patient reported gait disturbance as a donor site complication or any other major complication. The incidence of postoperative complications did not differ significantly between the elderly and younger groups. Almost no difference in postoperative course was seen between the groups. Elderly patients appear to tolerate free fibula flap reconstruction just as well as younger patients.     

腓骨瓣及CAD/CAM技术在重建下颌骨缺损中的应用

目的　探讨应用腓骨瓣及CAD/CAM技术修复大面积下颌骨缺损的经验。方法　根据16例患者下颌骨缺损的部位和特征,通过螺旋CT扫描获取缺损区的数据,在软件中应用CAD/CAM技术模拟下颌骨切除及重建手术,利用快速成型机加工制作出实物模型,依据模型对腓骨进行塑形、钛板重建,恢复下颌骨的形态和功能。结果　CAD/CAM技术的应用使术中截骨、腓骨塑形、定位速度明显加快;术后患者面部外形基本对称,影像学检查显示下颌骨缺损区的重建形态及固位良好;无严重并发症。结论　腓骨瓣联合CAD/CAM技术重建下颌骨缺损,能够明显缩短手术时间,提高手术质量,保证手术效果,是值得推广的重建下颌骨缺损的理想方法。     

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。     

Rehabilitation of a bilateral maxillectomy patient with a free fibula osteocutaneous flap

Rehabilitation of patients who have undergone bilateral maxillectomy is difficult because of extensive loss of bone and soft tissue. In this clinical report, prosthodontic rehabilitation of oral function in a bilateral maxillecitomy patient combined with a new fibular osteocutaneous flap, which was designed to have two oronasal slits for the retention of an obturator prosthesis, was described. A 58-year-old man with a maxillary alveolar carcinoma underwent bilateral maxillectomy. The defect was reconstructed using a vascularized fibular bone wrapped circumferentially with a peroneal flap, which was fixed with miniplates between the right malar prominence and cut edge of the left zygoma remaining two slits anterior and posterior to the graft. Two and half weeks after the surgery, a delayed surgical obturator was delivered and an obturator prosthesis was delivered 6 weeks after the surgery. This obturator prosthesis could be extended into the slits to engage the tissue undercuts, and was stable during use. Mastication, deglutition, articulation and the mid-facial profile of the patient were rehabilitated. After installation of the obturator prosthesis, relining of the prosthesis base was carried out alongside the healing process of the graft, and adjustment of occlusions and high-pressure spots was carried out. No clinical disorders were observed either in the grafted tissue or the obturator prosthesis with a 3-year prognosis. Newly designing a fibular osteocutaneous flap combined with tissue-borne obturator prosthesis is one successful approach to the restoration of oral function, and increases the patient's quality of life after bilateral maxillectomy.     

Risk factors for postoperative delirium in patients undergoing free flap reconstruction for oral cancer

The aim of this study was to investigate risk factors for postoperative delirium in patients undergoing free flap reconstruction for defects after oral cancer resection. This was a non-randomized, retrospective cohort study involving 102 patients who underwent oral cancer resection and free flap reconstruction. Data were collected from the medical records. Postoperative delirium occurred in 34 patients (33.3%), of whom 27 were male and seven were female. High preoperative total protein and albumin, diabetes mellitus, history of smoking, use of hypnotics or antipsychotics, time until getting out of bed after surgery, and postoperative insomnia were significantly related to delirium in the univariate analysis (P < 0.05). In a multiple logistic regression model, high preoperative albumin (odds ratio 4.45), postoperative insomnia (odds ratio 10.72), and history of smoking (odds ratio 2.91) were significant risk factors for delirium (P < 0.05). The analysis of laboratory data before and after surgery showed greater decreases in albumin, total protein, and haemoglobin after surgery in patients with postoperative delirium than in those without this condition. These results show that the perioperative maintenance of nutritional status and early postoperative management of the sleep cycle are important to prevent delirium after oral cancer resection and free flap reconstruction.     

Long-term outcomes of implant-based dental rehabilitation in head and neck cancer patients after reconstruction with the free vascularized fibula flap

The study aimed at evaluating, comprehensively, implant-based dental rehabilitation in head and neck cancer patients after maxillofacial reconstruction with a vascularized free fibula flap (FFF).Data were obtained by retrospectively reviewing the medical records of patients treated in Amsterdam UMC-VU Medical Center. Dental implant survival and implant success according to the Albrektsson criteria were analyzed. Additionally, prosthetic-related outcomes were studied, with a focus on functional dental rehabilitation.In total, 161 implants were placed in FFFs, with a mean follow-up of 4.9 years (range 0.2–23.4). Implant survival was 55.3% in irradiated FFFs and 96% in non-irradiated FFFs. Significant predictors for implant failure were tobacco use and irradiation of the FFF. Implant success was 40.4% in irradiated FFFs and 61.4% in non-irradiated FFFs, mainly due to implant failure and non-functional implants. Implant-based dental rehabilitation was started 45 times in 42 patients, out of 161 FFF reconstructions (27.9%). Thirty-seven patients completed the dental rehabilitation, 29 of whom achieved functional rehabilitation. Irradiation of the FFF negatively influenced attainment of functional rehabilitation. For patients with functional rehabilitation, the body mass index varied at different timepoints: FFF reconstruction, 24.6; dental implantation 23.5; and after placing dental prosthesis, 23.9.Functional implant-based dental rehabilitation, if started, can be achieved in the majority of head and neck cancer patients after FFF reconstruction. Actively smoking patients with an irradiated FFF should be clearly informed about the increased risk for implant and prosthetic treatment failure.     

Microvascular reconstruction of the mouth, face and jaws. Oromandibular reconstruction - free fibula flap

Dental surgeons may encounter in their clinical practice patients who present with aggressive pathologies that require early diagnosis and prompt treatment. This action may limit the extent of tissue damage and, where relevant, improve survival outcome. Clinicians should therefore be aware of the range of resective, reconstructive and rehabilitative options that are available in the management of these patients. We present our experience with the free fibula flap used for oromandibular reconstruction; this was undertaken in 21 patients following resective surgery for malignant pathology, cytologically benign but biologically aggressive odontogenic pathology and radiation induced osteonecrosis. We also review the history, surgical anatomy, surgical assessment and potential complications that are relevant to the free fibula flap.     

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。     

Outcome of partial mandibular reconstruction with fibula grafts and implant-supported prostheses

This study sought to evaluate the outcome of patients treated with fibula grafts for partial mandibular reconstruction and implant-supported prosthesis at a Danish university hospital. Patient inclusion criteria were: partial mandibular resection, reconstruction with a fibula graft, and treatment during the period 1998–2011. Patients with incomplete medical records were excluded. Thirty-six patients were included, of whom 16 were treated with an implant-supported prosthesis. Relevant presurgical, intraoperative, and postoperative parameters were registered. The fibula graft survival rate at the last follow-up (mean follow-up 22 months, range 0–89 months) was 97%. Half of the patients experienced non-severe complications such as loosening of osteosynthesis material, fistulae, and graft exposure. One of 37 fibula grafts in the 36 patients was removed due to infection. The implant survival rate was 96%; three of 67 implants were lost due to infection. Eight implants were not included in the prosthetic rehabilitation. Fibula graft surgery for mandibular reconstruction was found to be a reliable treatment modality with a high survival rate. Rehabilitation with implant-supported prostheses was characterized by high survival rates and few complications. The results obtained are comparable to those of previous studies.     

运用腓骨组织瓣修复下颌骨缺损

对6 例患者用腓骨瓣游离移植修复下颌骨缺损.手术采取血管吻合、坚固内固定方法恢复下颌骨形态及完整性.其中3 例患者为单纯腓骨瓣移植, 3 例患者为携带肌皮瓣或皮瓣的腓骨瓣移植.6 例患者平均随访6 月～2 年,成功率为100%.4 例患者可正常进食, 2 例患者可进软食.5/6的患者面部外形的恢复达满意或较为满意.所有患者均能正常行走,无1 例出现踝关节不稳定.带血管蒂的游离腓骨组织瓣具有其它自体骨组织瓣不可比拟的优点,是下颌骨缺损修复重建的最佳方法之一.     

游离腓骨瓣术后术肢康复训练的效果研究

目的 评价游离腓骨瓣术后患者下肢康复训练的效果,为该术后患者下肢功能恢复提供参考依据.方法 将59例游离腓骨瓣手术患者分为干预组(A组=28例)和对照组(B组=31例),A组接受系统下肢康复训练,B组无系统下肢康复训练,A、B组分别于手术前、术后2周、1～6个月,应用Enneking下肢功能评分系统进行主观评价,通过测量踝关节肿胀、内翻、外展、跖屈、背屈角度、(足母)趾肌力和抗阻力量进行客观评价.结果 ①术后3个月时,A组术侧踝关节肿胀发生率(61%)明显低于对照组(84%)(P<0.05);②术后6个月时,踝关节内翻评分(B组17.80±7.90、A组19.10±8.05)和外展(B组8.90±3.03、A组11.25±3.99),以及(足母)趾肌力评分(B组4.77±0.61、A组4.96±0.18)和(足母)趾抗阻力量评分(B组3.96±0.97、A组4.62±0.64),各项评分A组均明显高于B组(P<0.05);③术后6个月时,Enneking下肢功能评分系统中,在自我感受评分(B组4.5 ±0.5、A组4.5±0.1)、行走能力评分(B组4.5±0.5、A组4.9±0.3)和总分(B组27.5±1.4、A组28.2±1.1)方面,A组明显高于B组(P<0.01).结论 对游离腓骨瓣术后患者实施康复训练可促进患者下肢功能的恢复.     

游离腓骨瓣术后术肢康复训练的效果研究

目的 评价游离腓骨瓣术后患者下肢康复训练的效果,为该术后患者下肢功能恢复提供参考依据.方法 将59例游离腓骨瓣手术患者分为干预组(A组=28例)和对照组(B组=31例),A组接受系统下肢康复训练,B组无系统下肢康复训练,A、B组分别于手术前、术后2周、1～6个月,应用Enneking下肢功能评分系统进行主观评价,通过测量踝关节肿胀、内翻、外展、跖屈、背屈角度、(足母)趾肌力和抗阻力量进行客观评价.结果 ①术后3个月时,A组术侧踝关节肿胀发生率(61%)明显低于对照组(84%)(P<0.05);②术后6个月时,踝关节内翻评分(B组17.80±7.90、A组19.10±8.05)和外展(B组8.90±3.03、A组11.25±3.99),以及(足母)趾肌力评分(B组4.77±0.61、A组4.96±0.18)和(足母)趾抗阻力量评分(B组3.96±0.97、A组4.62±0.64),各项评分A组均明显高于B组(P<0.05);③术后6个月时,Enneking下肢功能评分系统中,在自我感受评分(B组4.5 ±0.5、A组4.5±0.1)、行走能力评分(B组4.5±0.5、A组4.9±0.3)和总分(B组27.5±1.4、A组28.2±1.1)方面,A组明显高于B组(P<0.01).结论 对游离腓骨瓣术后患者实施康复训练可促进患者下肢功能的恢复.     

Rehabilitation of long-term mandibular defects by whole-process digital fibula flap combining with implants: A case report

Currently, the gold standard and workhorse in mandibular reconstruction is the free vascularized fibula flap. Particularly for patients who have had mandibulectomy for a long time, it is still difficult to precisely reconstruct the mandibular contour and successfully restore the patient's chewing function and esthetics. For the restoration and rehabilitation of long-term mandibular abnormalities, three-dimensional (3D) virtual surgical planning (VSP) and 3D-printed surgical guides are essential. Digital design and manufacturing were used to improve the accuracy of prostheses and facilitate occlusal reconstruction. Therefore, equipped with the methods of 3D VSP, 3D-printed surgical guides, free vascularized fibular flap, and immediate dental implants, this clinical report provides a feasible solution for mandibular reconstruction.     

Long‐term outcome of dental implants placed in revascularized fibula free flaps used for the reconstruction of maxillo‐mandibular defects due to extreme atrophy

Purpose: The objectives of this study were to evaluate (a) the clinical outcome of revascularized fibula flaps used for the reconstruction of extremely atrophic jaws and (b) the survival rates of dental implants placed in the reconstructed areas. Materials and methods: Between 1999 and 2004, 12 patients presenting with extreme atrophy of the edentulous jaws were reconstructed with fibula free flaps. Five to 12 months after the reconstructive procedure, 75 titanium dental implants were placed in the reconstructed areas, while prosthetic rehabilitation was started 4–6 months afterward. The mean follow‐up of patients after the start of prosthetic loading was 77 months (range: 48–116). Results: An uneventful healing of the bone transplants occurred in all patients. One out of the 75 dental implants placed was not loaded due to prosthetic reasons. No dental implants failed to integrate before prosthetic loading, while three were removed during the follow‐up period. Despite the high survival rate of dental implants (95.8%), a relevant number of them presented relevant peri‐implant bone‐level loss, ranging from 1 to 7 mm for maxillary dental implants and from 1 to 4.5 mm for mandibular dental implants. Conclusion: Although no failures of the bone transplants occurred and a high long‐term survival rate of dental implants were observed, this study showed that fibula free flaps do not guarantee dimensional stability of peri‐implant bone, despite the immediate blood supply delivered by the vascular pedicle. The peri‐implant bone resorption was higher when compared with the one related to dental implants placed in native bone. To cite this article:
Chiapasco M, Romeo E, Coggiola A, Brusati R. Long‐term outcome of dental implants placed in revascularized fibula free flaps used for the reconstruction of maxillo‐mandibular defects due to extreme atrophy.
Clin. Oral Impl. Res. 22 , 2011; 83–91.
doi: 10.1111/j.1600‐0501.2010.01999.x     

游离腓骨复合组织瓣重建单侧上颌骨后可摘局部义齿修复的咀嚼功能研究

目的研究游离腓骨复合组织瓣重建一侧上颌骨缺损后常规局部叉齿修复的[牙合]力与咀嚼效率的恢复。方法选择北京大学口腔医学院游离腓骨复合组织瓣单侧上颌骨缺损修复的28例患者，测定戴用义齿前后健侧、患侧的[牙合]力及咀嚼效率的改变并进行比较分析。结果义齿修复侧上颌第一磨牙平均[牙合]力值为10．73kg，健侧上第颌一磨牙[牙合]力位平均为35．83kg，二者之闻差异有显著性（P〈0．05）。患者戴用义齿前咀嚼效率平均值为75．14％，戴用义齿咀嚼效率平均为81．53％，二者之间差异有显著性（P〈0．05）。结论腓骨复合组织瓣重建上颌骨缺损后有利于术后常规义齿的修复，显著提高了患者咀嚼效率，改善生活质量。     

Development of a novel resection and cutting guide for mandibular reconstruction using free fibula flap

Introduction

The authors developed a semi-standardised resection and cutting guide for mandibular reconstruction with free fibula flap based on data of mandible sizes and angles.

游离腓骨瓣术后术肢康复训练的效果研究

目的 评价游离腓骨瓣术后患者下肢康复训练的效果,为该术后患者下肢功能恢复提供参考依据.方法 将59例游离腓骨瓣手术患者分为干预组(A组=28例)和对照组(B组=31例),A组接受系统下肢康复训练,B组无系统下肢康复训练,A、B组分别于手术前、术后2周、1～6个月,应用Enneking下肢功能评分系统进行主观评价,通过测量踝关节肿胀、内翻、外展、跖屈、背屈角度、(足母)趾肌力和抗阻力量进行客观评价.结果 ①术后3个月时,A组术侧踝关节肿胀发生率(61%)明显低于对照组(84%)(P<0.05);②术后6个月时,踝关节内翻评分(B组17.80±7.90、A组19.10±8.05)和外展(B组8.90±3.03、A组11.25±3.99),以及(足母)趾肌力评分(B组4.77±0.61、A组4.96±0.18)和(足母)趾抗阻力量评分(B组3.96±0.97、A组4.62±0.64),各项评分A组均明显高于B组(P<0.05);③术后6个月时,Enneking下肢功能评分系统中,在自我感受评分(B组4.5 ±0.5、A组4.5±0.1)、行走能力评分(B组4.5±0.5、A组4.9±0.3)和总分(B组27.5±1.4、A组28.2±1.1)方面,A组明显高于B组(P<0.01).结论 对游离腓骨瓣术后患者实施康复训练可促进患者下肢功能的恢复.