腓骨复合组织瓣游离移植修复下颌骨缺损

我科从1993～1995年应用腓骨复合组织瓣游离移植修复半侧下颌骨缺损5例,移植骨全部成活,无感染,无吸收,取得了满意效果。1 手术方法1.1 设计测量肿瘤切除后下颌骨及相关软组织缺损范围,受区常选用颌外动、静脉或颈部血管以备吻合。供区于术前详细探测腓动脉并标记。如有较大面积软组织缺损则预制纸样置于供区,以大于纸样0.5～1cm 画出切取皮瓣的标记。1.2 腓骨复合组织瓣的切取及移植仰卧,供区下肢处于大腿内收,屈膝及小腿内旋位。从腓骨小头后侧开始,切开深层组织后显露腓总神经,再显露腓动、静脉,注意保护腓骨营养支。同时还应保护环     

下颌骨肿瘤切除后游离腓骨肌皮瓣一期修复16例

目的 总结下颌骨肿瘤切除后游离腓骨肌皮瓣修复下颌骨缺损的经验.方法 对16例应用游离腓骨肌皮瓣行下颌骨肿瘤切除后下颌骨缺损修复的病例作回顾性研究,分析了不同类型下颌骨的缺损,所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16患者游离腓骨肌皮瓣成活率100%.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.     

远端静脉留置管在腓骨肌瓣移植中血供监测的应用

自Hidalgo于1989年首次报告利用吻合血管的游离腓骨瓣修复下颌骨缺损以来[1],游离腓骨瓣在下颌骨重建中的应用迅即为头颈重建外科医师所接受.游离腓骨骨皮瓣已经成为修复各种类型下颌骨缺损最常用的方法[2].其修复部位通常为深部组织缺损,为了监测深部移植的游离组织瓣血供情况,2005年6月至2008年6月,我们对14例深部移植腓骨肌瓣设计外置的远心端静脉留置管观察血供,临床效果满意,报告如下.     

远端静脉留置管在腓骨肌瓣移植中血供监测的应用

自Hidalgo于1989年首次报告利用吻合血管的游离腓骨瓣修复下颌骨缺损以来[1],游离腓骨瓣在下颌骨重建中的应用迅即为头颈重建外科医师所接受.游离腓骨骨皮瓣已经成为修复各种类型下颌骨缺损最常用的方法[2].其修复部位通常为深部组织缺损,为了监测深部移植的游离组织瓣血供情况,2005年6月至2008年6月,我们对14例深部移植腓骨肌瓣设计外置的远心端静脉留置管观察血供,临床效果满意,报告如下.     

远端静脉留置管在腓骨肌瓣移植中血供监测的应用

自Hidalgo于1989年首次报告利用吻合血管的游离腓骨瓣修复下颌骨缺损以来[1],游离腓骨瓣在下颌骨重建中的应用迅即为头颈重建外科医师所接受.游离腓骨骨皮瓣已经成为修复各种类型下颌骨缺损最常用的方法[2].其修复部位通常为深部组织缺损,为了监测深部移植的游离组织瓣血供情况,2005年6月至2008年6月,我们对14例深部移植腓骨肌瓣设计外置的远心端静脉留置管观察血供,临床效果满意,报告如下.     

游离腓骨复合移植重建上肢关节功能及骨缺损

目的：吻合血管的腓骨复合移植适用于一期修复上肢长骨骨缺损及重建关节功能。方法：自１９８５年以来，采用折叠腓骨段及复合组织瓣修复尺桡骨同时骨缺损４例；小儿肱骨近端肿瘤瘤段切除后采用吻合血管带腓骨小头的腓骨移植重建肩关节功能９例；桡骨远端肿瘤瘤段切除后取吻合血管带腓骨小头的腓骨移植重建桡腕关节６例。结果：经术后２～１０年随访，重建的肩关节、桡腕关节功能恢复令人满意，尺桡骨骨缺损一期修复，骨愈合良好。结论：复合的游离腓骨移植是扩大应用于关节功能重建的有效方法。     

前臂严重复合组织缺损的急诊修复与一期功能重建

目的 报道游离组织瓣移植与一期功能重建急诊修复前臂严重复合组织缺损的疗效，方法 1994年3月至2003年8月，采用吻合血管的游离皮瓣移植、游离皮瓣与游离腓骨瓣移植或游离腓骨皮瓣移植，同时一期功能重建急诊修复4例前臂严重复合组织缺损。结果 4例均获得成功，经1～3年（平均1年8个月）的随访，骨支架愈合良好，皮瓣血运、质地、弹性好。拇指均可与手指对指，手部恢复保护性感觉。结论 游离组织瓣移植与一期功能重建手术是急诊修复前臂严重复合组织缺损的理想方法。     

折叠腓骨瓣一期修复下颌骨放射性骨坏死

目的 探讨采用折叠腓骨复合组织瓣一期修复下颌骨放射性骨坏死术后复合组织缺损的方法，并观察其临床疗效。方法 2004年5月至2005年4月，中山大学附属口腔医院口腔颌面外科采用折叠腓骨皮瓣一期修复下颌骨放射性骨坏死的临床病例共5例。制备腓骨皮瓣，在保持骨膜连续性的情况下，将腓骨截骨后自身折叠成“双管”型腓骨皮瓣，修复受区缺损。结果 5例腓骨皮瓣均成活。术后随访平均8个月，无严重并发症，术后颜面部基本对称，外形满意。复查X线片示腓骨皮瓣与健侧下颌骨骨结合良好，重建下颌骨高度满意，为义齿修复创造了良好的牙槽骨条件。结果 折叠腓骨复合组织瓣一期修复下颌骨放射性骨坏死的成功率高，有效修复了下颌骨及软组织复合缺损，临床疗效满意，值得临床推广应用；     

腓骨复合瓣游离移植修复下颌骨缺损

目的　总结应用游离腓骨复合瓣修复下颌骨缺损的经验。方法　 1999年 6月～ 2 0 0 0年 11月对5 8例应用腓骨复合瓣游离移植修复下颌骨缺损的病例作回顾性研究 ,其中男 37例 ,女 2 1例。年龄 12～ 6 5岁 ,平均4 0 .9岁。分析下颌骨缺损原因 ,分析腓骨瓣设计、受区血管、组织瓣成活情况及术后并发症的发生情况。结果　 5 8例中 5 2例为肿瘤切除术后修复 ,其中 4 3例为一期修复 ,9例为二期修复。采用游离腓骨复合骨瓣的腓骨长度 4～2 1cm ,平均 11.4 cm ;腓骨的截骨为 1～ 4次数 ,平均 2 .1次 ;骨瓣带皮岛最大范围 12 cm× 8cm,最小 3.0 cm×1.5 cm。术后游离腓骨瓣的临床成功率为 96 .6 % (5 6 /5 8) ,失败 2例。受供区并发症主要为血肿、积液、创口感染和腺瘘 ,有 4例为植皮坏死和创口感染 ,发生率为 2 4 .1% ,但不影响效果。结论　游离腓骨瓣在修复下颌骨缺损中具有操作灵活 ,安全可靠 ,制备简便 ,并发症少 ,可以满足各种类型下颌骨缺损修复的需要     

带腓血管蒂腓骨肌复合瓣的临床应用

肢体因肿瘤切除或外伤所致大段骨与肌组织联合缺损者,如能以带血供的骨肌复合瓣,一次完成骨和软组织缺损的修复并重建其功能,这样既缩短了疗程,又减轻了患者的痛苦和经济负担,乃最佳选择.如上供区,当以带腓血管腓骨肌复合瓣为首选,因可获得充分长度的骨与肌组织.作为腓骨肌复合瓣的肌肉必须与腓骨相邻,并能由腓动脉供血者,而且该肌肉被切取后,其原有功能可由其他肌肉部分代偿之.符合上述条件者有长屈肌、腓骨长肌和比目鱼肌外侧半[1-3].现就本复合瓣的解剖与临床应用要点分述如下.     

放射性下颌骨坏死术后缺损的游离腓骨肌皮瓣重建

目的 评价游离腓骨（肌）皮瓣重建放射性下颌骨坏死术后缺损的临床效果。方法 以带肌袖和不带肌袖的游离腓骨（肌）瓣重建放射性下颌骨坏死手术切除后的骨缺损，以皮岛修复瘘周软组织缺损，记录腓骨截骨、组织瓣存活情况，供区、受区并发症，术后张口度和余留牙咬合情况，对颌面部外形和功能重建进行评价。结果 随访3～16个月，4例带肌袖腓骨肌皮瓣、5例不带肌袖腓骨皮瓣重建下颌骨缺损均获成功。下颌骨截骨长度6、0～17．0cm，切取腓骨长度8．6～17．0cm。腓骨截成三段2例，二段5例，截成二段后折叠2例。无1例发生严重供区或受区并发症。所有病例外形恢复良好，双侧下颌角处于同一平面，无中线偏斜，开口度2．5～3．3cm，余留牙咬合正常。义齿修复后咀嚼功能满意。结论 游离腓骨（肌）皮瓣存活率高，外形和功能恢复好，适合于放射性下颌骨坏死术后颌面部软硬组织缺损的即刻重建。     

应用吻合血管的骨肌皮瓣修复下颌骨放射性骨坏死

目的探讨下颌骨放射性骨坏死所致颌面部组织缺损的修复手段。方法对下颌骨放射性骨坏死行死骨扩大切除术，同期用吻合血管的骨肌(皮)瓣移植修复颌面部组织缺损。共有髂骨肌皮瓣9例、髂骨肌瓣串联前臂皮瓣5例、腓骨肌皮瓣5例以及腓骨肌瓣串联前臂皮瓣1例修复20例下颌骨骨坏死。结果临床随访1～5年，除1例髂骨肌皮瓣坏死外其余均正常成活。吻合血管的骨肌皮瓣移植成功率达95％。结论下颌骨放射性骨坏死应行死骨扩大切除术，同期用吻合血管的骨肌(皮)瓣移植可以有效修复手术所致的颌面部组织缺损。     

吻合血管的游离复合皮瓣修复下颌骨及软组织缺损

目的　寻找一种既能同时满足修复下颌骨及软组织缺损需要 ,又符合牙种植条件的理想修复材料。方法　对 15例下颌骨复合组织缺损者行吻合血管的游离腓骨 -肌 -皮瓣复合组织移植修复。结果　 14例成功 ,颌面部外形、功能良好 ,利于牙种植。手术效果满意。结论　腓骨-肌 -皮瓣复合组织是目前修复下颌骨复合缺损的理想术式。     

腓骨骨皮瓣移植修复肢体复合组织缺损

目的总结腓骨骨皮瓣移植修复肢体外伤性复合组织缺损的临床修复效果。方法依照患者肢体复合组织缺失情况及全身状况,采用腓骨骨皮瓣移植进行修复,其中男9例,女3例。年龄12～45岁。胫骨缺损伴腓骨骨折2例,单纯胫骨缺损2例,桡骨缺损2例,尺骨缺损3例,跟骨缺损1例,第1跖骨缺损2例;骨缺损长度4.2～10.6cm,平均7.8cm;皮肤缺损10.0cm×4.5cm～27.0cm×15.0cm。合并胫前和(或)胫后动脉损伤2例,胫后神经损伤2例,腓总神经损伤1例。一期修复4例,延期修复8例。骨皮瓣游离移植手术9例,推移手术2例,逆行移位手术1例。4例于术后3～6个月行二期肌腱移位动力重建术。行腕、踝关节融合术各1例。结果术后出现静脉危象及腓总神经牵拉性损伤各1例,经探查、大隐静脉移植等对症治疗,12例骨皮瓣全部成活。术后随访6～24个月,移植腓骨与受区断端均达骨性愈合,肢体功能均得到良好恢复。供区未出现膝及踝关节运动障碍。结论采用急诊或延期的腓骨骨皮瓣移植手术,可较好地修复肢体长管状骨干和软组织复合组织缺损。应注意受区移植腓骨皮瓣术后的感觉功能重建。     

Simultaneous vascularized bony reconstruction of the maxilla and mandible using a single fibula: A case report

Simultaneous maxillary and mandibular reconstruction is exceedingly rare. These are complicated cases, requiring consideration of multiple variables: defect components, donor site morbidity, recipient vessels, and so forth. We describe a unique case of secondary maxillary/mandibular reconstruction in a 59‐year‐old male. The original defect was created after removal of a buccal squamous cell carcinoma, involving the external cheek skin, buccal mucosa, right mandibular body, and right inferior maxilla; a free vertical rectus abdominis musculocutaneous flap was used for the initial reconstruction. At the time of presentation to our clinic, the patient was tube‐feed‐dependent, unable to speak, and distressed regarding his appearance. We revised his reconstruction, rebuilding his maxilla and hemimandible using two free fibula flaps from a single fibula. The fibulae were vascularized via vein grafts and an ALT flap was used for external cheek resurfacing. All flaps survived and there were no complications at seven months since his surgery (when this report was written). The patient had intelligible speech and maintained adequate nutrition with a soft diet. Simultaneous vascularized bony reconstruction of the maxilla and mandible using a single fibula flap may be performed safely and with good outcomes.     

The free iliac crest and fibula flaps in vascularized oromandibular reconstruction: comparison and long-term evaluation.

BACKGROUND: A variety of free flaps have been successfully used for mandible reconstruction. This study compared the short- and long-term results of using the free iliac crest and fibula flaps. METHODS: We conducted a retrospective analysis of 117 patients who underwent mandibular reconstruction, 59 patients with iliac crest and 58 with free fibula. Accurate long-term functional assessment was possible in 31 cases in the iliac crest group and in 48 patients with fibular reconstruction. Anterior or combined anterolateral defects formed 72% and 64% in the iliac crest and fibula groups, respectively. The remainder were pure lateral defects. In both series, a skin paddle was included to provide either lining, skin cover, or both in 77% of the cases, whereas in 23% bone only was used. RESULTS: Complications included two perioperative deaths and three flap losses in the iliac crest group and five flap losses in the fibula group. Long-term functional and cosmetic assessment showed no statistically significant differences in oral continence (p > 0.9), speech (p = 0.57), and contour results (p = 0.80) between the two groups. However, oral deglutition was statistically significantly better in the fibula free flap group (p = 0.009). CONCLUSION: Although the fibula free flap is the flap of choice, the iliac crest is an excellent and reliable complementary flap for mandibular reconstruction.     

血管化游离腓骨肌皮瓣重建下颌骨缺损

目的：总结游离腓骨肌皮瓣修复下颌骨缺损的经验。方法：对25例应用游离腓骨肌皮瓣行下颌骨缺损修复的病例进行临床分析,探讨不同类型下颌骨缺损,所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25例患者游离腓骨肌皮瓣成活率100%,最长的腓骨为16cm,分为三段者3例,两段者20例。结论：血管化的游离腓骨肌皮瓣修复下颌骨缺损血供丰富、抗感染力强、骨愈合快、塑形好、成活率高。     

Complex oncologic reconstruction of a mandibular and floor of mouth defect with a fibula free flap in an achondroplastic patient

The fibular free flap is seen as one of the foremost technical options in mandibular reconstruction, especially in those defects where long bone is required. Cases with squamous-cell carcinoma of the floor of the mouth with mandibular spread and subsequent segmentary mandibular removal are the cornerstone examples. A case of squamous-cell carcinoma of the whole floor of the mouth with mandibular invasion is reported. Radical resection of the floor of the mouth and bilateral mandibular horizontal ramus was performed, with a bony defect extending from angle to angle. The patient revealed an achondroplastic condition, with remarkable dwarfism and long-bone morphological alterations, that minimized the potential fibular length to transfer. A microsurgical reconstruction with an osteocutaneous fibular free flap was undertaken. The flap design was technically compromised by the forward bowing of the fibula and the ossification of the interosseous membrane. Specific intraoperative strategies for dealing with anatomic variations are discussed. The fibular free flap is an excellent technique for mandibular reconstruction. Morphological deviations can modify the design of the flap. Achondroplasia is not a deterrent in successful use of the free fibula flap for reconstruction of the head and neck in adequately selected cases.     

Vertical distraction osteogenesis of fibula transplant for mandibular reconstruction: a case report.

Bone continuity defects in the mandible are caused by tumor surgery, trauma, infection, or osteoradionecrosis. Today, reconstruction of long-span mandibular defects with a free fibular flap is a routine procedure. However the bone height of the mandible after reconstruction is about half that of the dentulous mandible. Therefore, the deficiency in bone height makes implant placement impractical. In our case, because it was necessary to restore the mandibular height, a vertical distraction osteogenesis was performed on the grafted mandible of the patient who was referred to our clinic with a reconstructed mandible owing to a gunshot injury. As a result, the vertical discrepancy between the fibula and the native hemimandible of the patient was corrected. And the placement of dental implants was performed without any complications. In conclusion, we believe that the vertical distraction osteogenesis of free vascularized fibula flaps is a reliable technique that optimizes implant positioning for ideal prosthetic rehabilitation.     

15 years experience with microvascular free tissue transfert for repair of head and neck cancer defects

We present the modalities and results obtained with free flap reconstruction of head and neck cancers defects. This retrospective review of 165 free transfers performed between 1984 and 1999 included 89 radial forearm flaps (54%), 38 latissimus dorsi flaps (23%), 28 osteomyocutaneous flaps (17%), 6 omentum flaps (4%), 2 jejunum flaps, and 2 cutaneous scapular flaps. Indications were orobuccopharynx (34%), hypopharynx (24%), mandible (17%), craniofacial (15%) and skin (10%) defects. Flap failure rate was 9%. Reconstruction of a radiated site was a statistically significant indicator of flap failure. Four types of free flaps were preferred for reconstruction of head and neck cancer defects. The radial forearm flap was used as a lap flap for the orobuccopharynx, the tubuled radial forearm flap for reconstruction of the digestive tract after total pharyngolaryngectomy, the osteomyocutaneous free fibular flap for pelvimandibulectomy, especially for the anterior arch, the latissimus dorsi flap to fill craniofacial defects, and the free omentum flap for craniofacial complications after radiotherapy.