Use of a titanium cutting guide to assist raising the composite radial forearm free flap

The use of composite radial free tissue transfer has been overtaken by other composite flaps. This is due to donor site morbidity and the poor volume of bone yielded. The advantages and potential complications of composite radial flaps are well described. Use of the composite radial forearm free flap has been largely superseded in mandible reconstruction, but applications such as a salvage option still exist. Additionally it may be used in the reconstruction of midface defects. The use of a cutting guide to reduce the donor site complications and yet produce a maximal yield of bone is described herein. With the use of a skilled maxillofacial laboratory, the planning allows precise cuts and placement of the free flap and allows accurate prophylactic plating of the radius. A precise titanium cutting guide and custom distal radius plate are used. Details of three cases where these techniques have been implemented are described. The paper demonstrates the significant advantages of using laboratory-based technology to assist in performing composite radial free flaps. This paper reveals that composite radial free tissue transfer still has a place in the reconstruction of very selective defects of the head and neck. In particular, its use in reconstruction of Class 5 and 6 maxillary defects (Brown classification) is illustrated. Correct case selection and planning results in increased confidence to use this flap.     

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.

游离腓骨复合组织瓣同期修复上下颌骨缺损：1例报告

本文介绍1例游离腓骨瓣同期修复上下颌骨缺损,对其治疗设计及并发症作一临床分析。腓骨瓣同期修复上下颌骨缺损为颌骨重建提供了新思路,可应用于某些特殊病例的治疗,准确的术前设计及细致的腓骨塑形是手术的关键。本病例术后4个月上下颌移植腓骨块之间形成骨桥,导致张口受限,是血管蒂附带的腓骨骨膜成骨所致,再次手术切除骨桥及骨膜,并随诊2.5a,未再出现张口受限。     

外科模板在游离腓骨瓣修复上颌骨缺损术中的应用

目的 探讨外科模板在上颌骨切除同期自体腓骨瓣移植修复术中的作用。方法 7例因上颌骨肿瘤需行上颌骨切除术并同期自体腓骨瓣修复的患者，术前取研究模型，根据拟行的手术范围进行模型外科设计，确定牙槽突缺损范围，并将模型修整成需要重建的理想解剖形态，制作模板。外科医生在术中根据模板对腓骨瓣塑形，并确定腓骨瓣固定的位置。术后取研究模型观测腓骨瓣的就位情况，三维CT评价腓骨与下颌骨的相对位置关系。结果 经过外科模板的术中定位，腓骨瓣与下颌骨达到正常相对位置关系，垂直向间隙适合常规叉齿或种植义齿修复。患者戴用义齿后的咀嚼效率明显提高。结论 外科模板是修复医生和外科医生之间有效的交流载体，为患者术后功能和外形的恢复创造了有利条件。     

钛网与前臂游离皮瓣闭合式三维重建上颌骨缺损

目的：探讨应用钛网与前臂皮瓣对上颌骨缺损行闭合式三维重建方法的可行性。方法：自2000-03起，我们对10例上颌骨因肿瘤及外伤后缺损的病例，分别行上颌骨次全切除7例，全上颌切除3例，其中Ⅱ类缺损7例，Ⅲ类缺损3例，同期采用钛网支架对上颌骨各壁进行构筑，恢复其外形；并对暴露在口腔或鼻腔内的创面用前臂桡侧游离皮瓣行闭合式修复，结果：10例上颌骨缺损的病例经3-18个月随访观察，术后皮瓣全部成活，其中3例上颌全切的病例，采用了前臂游离皮瓣折叠修复，恢复了鼻腔，腭部，上颌牙槽及牙弓的外形，经CT检查证实，肿瘤未见复发，张口度2.5-4cm，进食时无食物从鼻腔返流，语言较为清晰，其中3例钛网支架构筑的外形已行可摘局部义齿修复，能进普食，2例上颌骨全切的病例修复术后6-12个月，经鼻咽内窥镜检查，可喜地发现儋 网内衬有正常软组织覆盖，结论：应用钛网支架构筑上颌骨缺损的外形，其上覆盖前臂桡侧游离皮瓣，此种闭合式三维重建上颌骨缺损的方法，经临床证实，术后基本恢复了上颌骨的外形和功能，该手术简便可行，有应用和推广价值。     

Use of medial upper arm free flap in oral cavity reconstruction: a preliminary study

The medial upper arm has previously been proposed as a potential free flap donor site, but the clinical application of such flaps in head and neck reconstruction has not been popular. The preliminary results of the clinical application of medial upper arm free flaps in oral cavity reconstruction are reported here. Five patients with oral cancer underwent surgical resection and neck dissection, with simultaneous reconstruction using a medial upper arm free flap. Functional outcomes were investigated using the University of Washington Quality of Life Questionnaire. Sensory-motor functions of the upper arm donor site were recorded before and after surgery. Four flaps were successfully transferred. One flap was abandoned during surgery because of a lack of perforators, and a forearm flap was used instead. All patients survived without loco-regional recurrence or distant metastasis. Functional outcomes, especially swallowing and speech, were satisfactory. The donor site scar was well hidden, with no functional impairment. This initial experience shows that the medial upper arm free flap represents an alternative perforator flap for oral cavity microsurgical reconstruction. The well-hidden scar and better texture match compared with other flaps make it suitable for oral cavity reconstruction.     

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.     

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。     

个性化钛网结合游离组织瓣修复上颌骨缺损

目的 探讨个性化钛网结合游离组织瓣修复上颌骨缺损的临床效果.方法 选取2010年5月~2016年5月期间江门市中心医院收治的上颌骨缺损患者36例作为研究对象,采用个性化钛网结合游离组织瓣修复方案,总结、探讨该治疗方案的临床应用价值.结果 随访期6~36个月,组织瓣成活率100%,肿瘤复发率5.56%,满意度为100%;无复视发生;无吞咽障碍发生;患者咀嚼功能有所下降,并且出现咀嚼时间变长的情况;而在语言沟通方面未受到影响.结论 应用个性化钛网与游离组织瓣相结合的方式修复上颌骨缺损患者,临床修复效果较好,可有效改善患者生活质量,但在后期义齿修复时仍有困难.     

髂骨复合瓣与前臂皮瓣串联重建大型下颌骨复合缺损

由于恶性肿瘤的根治性切除致下颌骨大型复合缺损３例，采用髂骨复合瓣与前臂皮瓣串联重建，其中１例切取双侧髂骨复合瓣。３例病人７块皮瓣全部成活，随访３～１２月，供受区外形及功能结果较满意，经Ｘ摄片随访观察显示移植骨愈合改建过程迅速，骨吸收量少。结果表明，前臂皮瓣可弥补髂骨复合瓣携带皮岛的不足，两者串联应用是重建下颌骨大型复合缺损的一种理想方法。     

Lateral segmental mandibulectomy reconstruction with bridging reconstruction plate and anterolateral thigh free flap: a case series of 30 consecutive patients

Lateral posterior segmental mandibular defects present a reconstructive challenge and an osseous flap would be the gold standard to reconstruct such a defect. However, combining a mandibular reconstruction plate (MRP) with a soft-tissue free flap (to restore mucosal integrity and provide durable coverage of the plate itself) offers an alternative option for posterior segmental mandibular defects in patients who are not suitable for osseous reconstruction, or do not choose it. We retrospectively reviewed 30 consecutive patients (19 male and 11 female) who underwent reconstruction of a segmental mandibulectomy defect using a bridging MRP and anterolateral thigh (ALT) free flap. The mean (range) age was 67 (31-87) years. The American Society of Anesthesiologists’ (ASA) status of the study population comprised Grade 1 (n = 10), Grade 2 (n = 18), and Grade 3 (n = 2). The majority of patients had oral cavity squamous cell carcinoma (n = 26) involving the mandible, two had osteoradionecrosis, and two mucoepidermoid carcinoma. Four patients had complications specific to the reconstruction, and flap loss occurred in one (96.7% success rate). Metalwork infection occurred in three, including one plate extrusion and one plate fracture. The median length of stay was 10 days, and mean (range) duration of follow up 23.3 (1-96) months. This technique is an alternative reconstructive option for the non-tooth-bearing mandible. Reconstructing a posterolateral segmental mandibulectomy defect with a bridging MRP and ALT free flap offers a robust reconstructive alternative with a favourable complication profile.     

Surgical management of severe osteoradionecrosis of the mandibular bone by using double free flap reconstruction

Purpose

Osteoradionecrosis (ORN) of the jaws represents one of the most severe complications after primary or adjuvant radiation therapy (RT) of large head and neck tumors. In advanced ORN cases, surgical management is generally considered the therapy of choice. However, in several severe ORN patients with extensive bone and soft tissue defects, functional and aesthetic reconstruction represents a huge challenge for any surgeon, with an increased risk of post-operative wound healing disorders. Our aim here was to perform a double free flap technique as a therapeutic option in this difficult patient collective and to evaluate the post-operative outcome.

Periosteal ossification of the vascular pedicle after reconstruction of continuity defects of the mandible and the maxilla with fibular free flaps: A retrospective study

Periosteal ossification of the vascular pedicle of a fibular free flap after reconstruction of mandibular and maxillary continuity defects has been thought to be rare. The purpose of this study was to evaluate its incidence and contributory factors to its development.     

Pregnancy and childbirth after an iliac crest free flap

We report two successful pregnancies and vaginal deliveries by patients who had previously had deep circumflex iliac artery free flaps that had been harvested for reconstruction in the head and neck.     

游离皮瓣移植修复口腔颌面部缺损的临床效果观察

目的探讨游离皮瓣在修复口腔颌面部缺损中的临床应用价值。方法选择2006年03月—2010年08月中国医科大学口腔医学院口腔颌面外科用游离皮瓣修复口腔颌面部缺损病例168例,前臂游离皮瓣90例,股前外侧游离皮瓣39例,腓骨肌皮瓣31例,背阔肌皮瓣8例。术后观察皮瓣成活率和并发症。结果成功164(97.6%)例,失败4例,患者出现术后早期局部并发症6.5%(11/168),术后皮瓣危象发生率为5.4%(9/168),其中静脉血栓形成66.7%(6/9),手术探查抢救成功率55.6%(5/9),前臂桡侧皮瓣成活率97.8%(88/90);股前外侧皮瓣成活率97.4%(38/39);腓骨肌皮瓣成活率96.8%(30/31);背阔肌皮瓣8例全部成活,随访2～2.5年大部分患者外形及功能满意。结论游离皮瓣修复口腔颌面部缺损的成活率高,前臂皮瓣、股前外侧皮瓣、腓骨肌(皮)瓣、背阔肌皮瓣是修复口腔颌面部缺损的常用皮瓣。     

血管化腓骨肌瓣移植重建下颌骨缺损的外科改良

目的:对重建下颌骨缺损的血管化腓骨肌瓣制备和塑形方法进行外科改良。方法:(1)非驱血状态下于大腿安放电子止血带加压后直接进行腓骨组织瓣制备;(2)暴露腓骨后,在待取腓骨的上下端各截除小段骨再实施腓骨的带血管制备;(3)对腓骨施行阶梯状截骨塑形。结果:7例腓骨瓣制备和术后出血(渗血)少,制备时间缩短。术后均一期成活,未发生感染或其他并发症。骨段固定稳固,下颌轮廓和外形良好。结论:(1)非驱血制备腓骨瓣不增加出血机会,反而减少出血机会,简化手术操作;(2)在待取腓骨的上下端截除小段骨可以使待取腓骨段充分游离,便于带血管制备和减少损伤血管的机会;(3)阶梯形截骨塑形,既增加了骨断面的接触面积和稳定性,又避免了楔形切骨骨量的丧失。     

������֯���޸�ȫ�´���򤲿��Χȱ���ٴ��о�

目的探讨游离皮瓣在全下唇及颏部大范围缺损修复重建中的应用价值及临床效果。方法 2007年7月至2013年3月,对中国医科大学口腔医学院口腔颌面外科收治的12例下唇癌根治术后及2例外伤造成的全下唇及颏部缺损患者,应用前臂皮瓣和股前外侧皮瓣同期修复。术后随访6个月至3年,并对患者修复后下唇外观和功能进行评价。结果 14例皮瓣全部成活,成活率100%。术后随访下唇癌患者肿瘤未见复发,14例患者均可进行基本正常的语言交流;12例可进普食,2例进软食;1例流涎,均无小口畸形。下唇及颏部外观患者均能接受。结论应用游离皮瓣修复全下唇及颏部缺损,方法安全可靠且成功率较高,根据下唇及颏部缺损范围选择合适修复方式可获得较好的口腔功能和外观。