血管化游离腓骨瓣在下颌骨重建中的应用

目的评价应用血管化游离腓骨瓣移植重建下颌骨的临床疗效。方法对6例下颌骨缺损患者采用血管化游离腓骨瓣同期移植修复。结果5例腓骨肌瓣完全成活,1例腓骨肌皮瓣移植患者皮岛坏死,但腓骨瓣成活：所有患者术后外形良好,术后3个月x线片示移植骨无吸收,骨断端愈合良好;所有患者均行走正常,无1例出现踝关节不稳定。结论血管化游离腓骨瓣血供良好,骨量充足,易于塑形,适合于下颌骨缺损的重建。     

血管化腓骨组织瓣游离移植修复下颌骨缺损

目的:探讨血管化腓骨修复各型下颌骨缺损的可行性。方法:对14例因各种原因所致下颌骨缺损患者采用血管化游离腓骨瓣同期移植修复。结果:骨瓣存活成功率100%;下颌骨形状和功能恢复良好。术后3个月摄片示移植骨无吸收,骨段愈合良好。面部外形恢复均达到满意或较为满意。所有患者均能正常行走,无1例出现踝关节不稳定。结论:游离腓骨瓣血供良好,骨量充足,可塑性强,特别是对全下颌骨缺损的修复,具有目前临床常用的其他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。     

腓骨肌(皮)瓣一期整复下颌骨缺损

目的　应用游离腓骨肌 (皮 )瓣一期整复下颌骨缺损。方法　以腓动静脉为血管蒂切取腓骨肌瓣 ,根据下颌骨缺损的特点 ,对腓骨进行截骨塑形 ,按定位钢板定位后的下颌骨缺损形态和长度准确就位 ,用小钛板或重建板进行移植骨坚固内固定。结果　 18例腓骨肌瓣重建下颌骨缺损全部获得成功。腓骨截成二段者 10例 ,三段者 3例 ,5例未截断。术后伤口均一期愈合 ,术后面部外形恢复满意者 16例 ,咬合关系正常者 14例 ,张口度正常者 14例 ,3例患者术后接受活动义齿修复 ,1例行种植义齿修复并获得良好的咀嚼功能。结论　腓骨肌瓣是重建下颌骨缺损的理想组织瓣 ,其具有骨量充足、外形好、成功率高等优点。     

带血管蒂腓骨组织瓣游离移植修复下颌骨缺损的临床研究

目的:评价带血管蒂腓骨组织瓣游离移植修复下颌骨缺损的临床应用价值。方法:对25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22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,3例患者还同期植入种植体共5枚。结果:25例患者平均随访917个月,成功率为96%。3个患者的5枚种植体均达到良好的骨整合效果,并已行上部义齿的修复。62% 的患者可正常进食,余38%的患者可进软食。96%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。结论:带血管蒂的游离腓骨组织瓣具有众多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。     

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目的评价腓骨肌皮瓣游离移植修复下颌骨复合缺损的临床应用价值。方法自2006年3月至2008年12月中国医科大学口腔医学院口腔颌面外科共行腓骨肌皮瓣游离移植修复下颌骨缺损手术12例,手术采取血管吻合、坚固内固定方法恢复下颌骨的形态及功能。结果12例患者术后随访3个月至2年,组织瓣全部成活,下颌骨外形及功能满意,无1例髁关节不稳定。结论腓骨肌皮瓣可提供良好血供及足够软、硬组织量,是下颌骨复合缺损修复的较好供体。     

游离腓骨肌(皮)瓣在下颌骨缺损修复重建中的应用

目的总结游离腓骨肌(皮)瓣一期重建下颌骨节段性缺损的方法、经验和临床效果。方法对11例下颌骨节段性缺损的患者同期采用游离腓骨瓣进行重建,其中腓骨肌瓣6例,腓骨肌皮瓣5例。对术后供区和受区的功能和外形进行评价,分析总结临床方法和经验。结果11例血管化游离腓骨肌(皮)瓣移植全部成功,所有病例供区伤口均一期愈合,供区下肢均无明显功能障碍,患者术后面部外形对称,张口度3.5～4.2cm。结论游离腓骨肌(皮)瓣是重建下颌骨节段性缺损的理想方法。     

血管化腓骨游离移植重建下颌骨缺损及同期种植体植入

目的：介绍血管化腓骨游离移植即刻重建下颌骨缺损并同期植入牙种植体的方法。方法：对2例下颌骨造釉细胞瘤骨缺损行血管化腓骨游离移植重建，于术中同期植入Frialit-2台阶柱状牙种植体，术后进行临床和影像学追踪观察。结果：2例患者面部外形恢复满意，咬合关系正常，X线与CT检查骨愈合良好，骨重建形态与种植体位置满意．结论：血管化腓骨游离移植与同期牙种植体植入重建下颌骨缺损可有效地恢复面部外形和口腔生理功能。     

游离腓骨瓣修复下颌骨缺损：附9例报道

目的探讨腓骨肌（皮）瓣游离移植修复下颌骨成釉细胞瘤术后缺损临床效果。方法对2009年8月至2010年7月在我院收治的9例行下颌骨成釉细胞瘤切除术的患者,行血管化腓骨肌（皮）瓣下颌骨重建。结果 9例游离腓骨瓣全部成活。下颌骨形态和功能恢复正常,咬合良好。结论游离血管化腓骨肌（皮）瓣游离移植是修复下颌骨大段或中部缺损的重要方法。     

游离腓骨肌皮瓣修复下颌骨缺损10例临床分析

目的总结游离腓骨肌皮瓣修复下颌骨缺损的经验。方法对10例应用游离腓骨肌皮瓣行下颌骨缺损修复的病例作回顾性研究,分析不同类型下颌骨的缺损采用腓骨肌皮瓣的设计、复合组织瓣的成活情况及术后并发症的发生情况。结果本组10例患者游离腓骨肌皮瓣全部成活。结论血管化的游离腓骨肌皮瓣修复下颌骨缺损具有血供丰富、抗感染力强、骨愈合快、成活率高等优点。     

腓骨肌(皮)瓣平行折叠结合人工关节重建下颌骨缺损

目的:采用腓骨肌(皮)瓣平行折叠技术改善单段腓骨重建下颌骨所致的高度不足,并结合人工关节重建下颌骨大型缺损。方法:对13例下颌骨大型节段性缺损患者,采用腓骨肌(皮)瓣平行折叠技术重建。术前均采用CAD/CAM技术制作个体化头模、设计腓骨修复的位置及高度。根据缺损部位,分别采用下颌体平行折叠或部分平行折叠,对缺损累及下颌体、下颌支及髁突者,则结合人工关节一并修复。结果:移植腓骨肌(皮)瓣全部成活,下肢供区无并发症。面部外形满意,开口度2.5～3.5cm,重建下颌骨的高度低于健侧,在-0.3～1.5cm之间,平均0.47cm,种植义齿与余留牙咬合关系正常、发音清晰。复查全景片及三维CT,显示腓骨骨段的位置和高度与术前设计一致,髁突或人工关节位于关节窝内。结论:腓骨肌(皮)瓣平行折叠技术及结合人工关节为重建半侧下颌骨大型缺损,以及增加其高度提供了一种较为简单可行、效果良好的修复手段。建议在主要承担咀嚼功能的颏部和体部行平行折叠植骨,在非承担咀嚼功能的下颌支,则使用人工材料。     

两种血管化游离骨肌瓣移植修复下颌骨缺损临床分析

目的:评价血管化游离髂骨肌瓣和腓骨肌瓣移植修复下颌骨缺损的临床效果,比较两种修复方法的优缺点。方法:对44例血管化髂骨肌瓣和腓骨肌瓣移植修复下颌骨缺损的病例进行回顾性研究,分析两种骨肌瓣修复后对患者面部外形与口腔功能的影响,对比供受区并发症的差异。结果:20例髂骨肌瓣,24例腓骨肌瓣均成活;二者在恢复面部外形与口腔功能上无明显差异,在移植骨长度上,两者有明显不同。结论:血管化游离髂骨肌瓣与腓骨肌瓣作为下颌骨缺损修复的常用方法,可以满足不同类型下颌骨缺损修复的需要,但根据两种骨肌瓣的特点,对于缺损长度低于8 cm,可优先考虑髂骨瓣,而缺损范围大于8 cm的可选腓骨瓣。     

Vascularized free fibular flap for mandibular reconstruction: a report of 26 cases.

PURPOSE: Mandibular reconstruction represents a challenge to the oral and maxillofacial surgeon and has been revolutionized by the modern microvascular techniques. Rehabilitation using techniques such as reconstruction plates frequently produce a functional and cosmetic defect. The primary objective of the current study was to evaluate the usefulness of the osteomuscular free fibular flap for this purpose. PATIENTS AND METHODS: The results of 26 vascularized free fibula flaps with or without a skin paddle that were used for mandibular reconstruction is presented. The "double barrel" technique was used in 6 cases. The donor site was closed directly in 2 cases and with an abdominal full-thickness skin graft in 24 cases. RESULTS: All flaps except 1 were viable. There was partial necrosis of the skin island in 1 patient. The average length of the fibula graft was 10.96 cm, and the number of osteotomies ranged from 0 to 3. In the donor site, the most significant problem was unsatisfactory scarring related to the use of a skin graft. There were no long-term functional complications in the lower leg. Two patients have been secondarily rehabilitated with osseointegrated implants. CONCLUSION: The fibula flap provides a successful bone graft for mandibular restoration with an acceptably low complication rate. This method meets most of the requirements for oral and mandibular replacement.     

Three different techniques for mandibular reconstruction after hemimandibulectomy.

Mandibular reconstruction is a condition in which both bone defect and function must be restored. A wide range of approaches--from grafts to distant bone flaps--have been used for correcting bony defects. However, adequate mastication has been restored in only a few cases. In this article the results of three different techniques for mandibular reconstruction after hemimandibulectomy were studied. Sixteen patients underwent a second mandibular reconstruction after hemimandibulectomy and were monitored at least 1 year. Three different techniques were used: (1) full-thickness galeoparietal bone flap (eight patients), (2) free iliac crest graft (three patients), and (3) free fibular grafts (five patients). Occlusion on the nonoperated side and the possibility and function of osseointegrated denture in the vascularized bone transfer were evaluated. The full-thickness galeoparietal flap and free iliac crest bone flap appeared to be good options. However, only acceptable or poor occlusion could be achieved on the normal side. The fibular free flap demonstrated good results and good occlusion. Nonetheless, dental implantation was difficult because a prosthesis for reaching the normal height of the mandible was necessary.     

Functional reconstruction of mandible by using vascularized fibular free flap and one-stage rehabilitation of the implant]

OBJECTIVE: To study the characteristics of the vascularized fibular free flap and the possibility of the insertion of implant at the same time. METHODS: The microvascular surgical procedure and implant technique were used in the treatment of two cases suffered from mandibular ameloblastoma. After tumor resection by partial mandiblectomy, graft of vascularized fibular free flap was performed with simultaneous insertion of 5 implant. RESULTS: One year later, the grafted bone was survival, the osseointegration was proceeded between the implant and grafted bone. The functional reconstruction of the mandible was excellent after prosthetic denture. CONCLUSION: This is a good approach to rehabilitate bone function by using vascularized fibular free flap and one-stage implant placement.     

Concomitant reconstruction of mandibular basal and alveolar bone with a free fibular flap

Repair of long-span mandibular defects with a free fibular flap is now a routine procedure. However, the bone height of the neo-mandible after reconstruction with a fibular flap is about half that of the dentulous mandible. When a fibular graft is placed only at the inferior border of the mandible, the resulting vertical discrepancy between the graft segment and the occlusal plane can adversely affect implant mechanics or denture stability and retention. To overcome these problems, we developed a technique for two-strut type mandibular reconstruction. A vascularized fibular segment is used to reconstruct the inferior basal portion of the neo-mandible, while a non-vascularized residual fibular segment is used to simulate the superior alveolar portion. We used this technique in 22 patients. Graft survival, graft resorption, and the ability to place implants were assessed as compared with those after the conventional one-strut type technique. The fibular segment grafted to the alveolar region was removed in one patient with intraoral wound dehiscence and in two with postoperative infection. All vascularized fibular flaps were successful. The resorption rate was 13.6+/-7.2% for non-vascularized segments and 3.0+/-3.7% for vascularized segments. Dental implants were placed in five of our 22 patients. The crown:fixture length ratio was improved to 1:1.7, as compared with a ratio of 1:1.21 with use of a conventional fibular flap. We conclude that our technique is very easy and safe and provides substantially improved lower-lip and cheek support and implant-prosthetic mechanics than conventional procedures for the repair of long-span mandibular defects.     

腓骨肌皮瓣加种植体植入对颌面部软硬组织缺损的功能重建

目的:总结应用腓骨肌皮瓣游离移植对颌面部软硬组织缺损的功能重建的临床经验。方法:自2007～2011年7月,我科应用腓骨肌皮瓣一期修复下颌骨及周围软组织缺损11例,其中男性8例,女性3例,年龄33～67岁,其中左下颌牙龈鳞癌4例,右下颌牙龈鳞癌2例,右舌下腺腺样囊性癌1例,右口底鳞癌2例,左下颌黏液表皮样癌1例,成釉细胞瘤1例。其中磨牙后区粘液表皮样癌和成釉细胞瘤2例进行即刻种植。受区血管均为同侧,组织瓣均吻合1根动脉、2根静脉。动脉选用颈外动脉分支,静脉选用面总静脉、颈前静脉或颈外静脉,所有动静脉吻合均采用端端吻合法。分析皮岛的设计、大小、修复部位、存活情况等。结果:本组游离腓骨肌皮瓣11例全部成活,均携带1块皮岛,由一个穿支供养,皮岛最大6cm×4cm,最小3cm×2cm,皮岛均用于口内软组织缺损修复,2例即刻种植植入种植体6颗。术后面部外形、功能及咬合关系良好。语音功能基本正常。下肢功能在术后3～6个月恢复正常。结论:腓骨瓣的骨量充足,具有骨膜和骨髓双重血供,血运丰富,抗感染能力强,移植后易于成活。可根据需要做多段截骨塑形从而更加准确的恢复颌骨牙槽突形态。操作过程中远离头颈部,可以双组同时手术。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。游离腓骨瓣的皮岛不仅可用于口内外的软组织缺损修复,还可作为术后血供的观察窗。腓骨肌皮瓣在修复颌面部软硬组织缺损中具有血供安全可靠,塑形灵活,模拟外形准确,利于监测,并发症少等优点,是能够同时兼顾颌骨缺损及周围软组织缺损修复重建的理想方法。     

血管化骨移植修复颌骨严重缺损并种植义齿修复

目的:颌骨外伤、肿瘤或其他疾病常导致上下颌骨严重缺损,此时如何重建口腔颌面部的形态和功能一直是口腔修复的难点和挑战。本研究旨在观察血管化骨移植修复颌骨缺损并种植义齿修复的临床效果。方法:对12例颌骨严重缺损患者行血管化髂骨肌瓣或血管化腓骨肌皮瓣修复骨缺损,对牙列缺损患者采用手术导板指导移植骨块的定位,7例患者在导板指导下行同期牙种植体植入术。5例患者在术后4～6月行延期牙种植体植入术。3～4月后行种植义齿修复,其中种植覆盖义齿4例,种植固定义齿8例。结果:所有病例的血管化自体骨移植均获成功。种植义齿修复后经3～24月的临床观察,X片显示种植体与移植骨间未见透射影,2例发生种植体周围软组织增生,患者对形态和功能恢复感到满意。结论:血管化骨移植并种植义齿修复用于颌骨严重缺损的功能重建可获得良好的临床效果,其远期疗效有待进一步观察。     

The use of free fibular flap for functional mandibular reconstruction.

PURPOSE: The purpose of this investigation is to document our experience using the free vascularized fibular flap for comprehensive reconstruction of discontinuity defects in the mandible, after combined resections of malignant and aggressive odontogenic tumors, with special emphasis on functional aspect of the reconstruction process. MATERIALS AND METHODS: The study group consisted of consecutive patients treated for reconstruction of discontinuity defects of the mandible, using the fibular vascularized free flap, between 1997-2002. All procedures were performed in the same hospital and by the same surgical team. RESULTS: A total of 13 patients (9 males, 4 females) were treated in our department in a period of 6 years for reconstruction of discontinuity mandibular defects using the free fibula vascularized flap. Wound healing disturbances at the donor site occurred in 4 cases. Two flaps were lost, 1 because of total failure in a patient who was heavily irradiated because of osteosarcoma, the other because of resorption of the bone tissue transfer in a case of total avulsion of the mandible caused by a fall from height. CONCLUSION: Fibula free vascularized flap is a safe and reliable method for comprehensive functional and esthetic mandibular defect reconstruction. Our protocol has a significant impact on preserving the patients quality of life.     

腓骨肌(皮)瓣一期修复下颌骨缺损

目的：总结应用腓骨肌（皮）瓣一期修复下颌骨缺损的经验.方法：根据7例患者下颌骨缺损的部位和特征,对其腓骨进行截骨和塑形,以恢复其下颌骨的形态和功能,并以大钛板进行坚固内固定.结果：7例以腓骨肌（皮）瓣修复下颌骨缺损患者全部成功,伤口愈合良好.结论：腓骨肌（皮）瓣可根据下颌骨缺损的部位和形态进行截骨和塑形,是用来修复下颌骨缺损的一种理想的方法.