游离腓骨肌-皮-筋膜复合瓣同期修复40例放射性下颌骨坏死术后缺损效果评价

目的： 探讨游离腓骨肌-皮-筋膜复合瓣在修复下颌骨放射性骨坏死（osteoradionecrosis of the jaws，ORNJ）术后软、硬组织缺损的应用价值。方法： 选择2014年3月—2017年7月间，中山大学孙逸仙纪念医院口腔颌面外科40例下颌骨 ORNJ患者，所有病例原发肿瘤均为鼻咽癌，排除鼻咽癌复发。以游离腓骨肌-皮-筋膜复合瓣重建放射性下颌骨坏死手术切除后的骨缺损，以皮岛修复皮肤软组织缺损，以筋膜修复口内黏膜缺损并充填软组织缺损的空腔，记录腓骨截骨、组织瓣存活情况，供区、受区并发症，术后开口度和余留牙咬合情况，对颌面部外形和功能进行评价。结果： 随访3～6个月，游离腓骨肌-皮-筋膜复合瓣重建下颌骨缺损均获成功。下颌骨截骨长度5.5～16.0 cm，切取腓骨长度7.5～17.0 cm。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，开口度1.0～3.5 cm，余留牙咬合正常。结论： 游离腓骨肌-皮-筋膜复合瓣能很好地即刻重建放射性下颌骨坏死术后颌面部软、硬组织缺损，降低手术并发症，值得临床推广应用。

Efficacy and safety of reconstruction of mandibular defect in 40 patients with osteoradionecrosis of the jaw with free fibular osteomyofascial compound flap

PURPOSE: To explore the clinical efficacy of free fibular osteomyofascial compound flap in mandibular defect reconstruction in patients with osteoradionecrosis of the jaws (ORNJ). METHODS: From March 2014 to July 2017, 40 patients with mandibular ORNJ undergoing oral and maxillofacial surgery at Sun Yat-sen Memorial Hospital of Sun Yat-sen University were enrolled. All patients had primary nasopharyngeal carcinoma, excluding recurrent nasopharyngeal carcinoma. Free peroneal dermis fascia composite flap was used to reconstruct bone defects after surgical resection of the radiated mandibular necrosis. The skin and soft tissue defects were repaired with skin island. Fascia was used for mucosal defect repair to fill the soft tissue defects. The fibular osteotomy and tissue flap survival, donor, complications, postoperative mouth opening and occlusion of remaining teeth were evaluated for reconstruction outcomes. RESULTS: After 3 to 6 months of follow-up, free fibular peroneal fascial composite flap was successfully used to reconstruct mandibular defects. Mandibular osteotomy was 5.5-16.0 cm in length, and the harvested fibula was 7.5-17.0 cm in length. No patient had serious donor or recipient site complications. All patients had satisfactory facial shape, remaining normal occlusion, and mouth opening was 1.0-3.5 cm. CONCLUSIONS: Free fibular peroneal fascia composite flap can reconstruct maxillofacial soft and hard tissue defects after radio in patients with ORNJ and reduce complications, which is worthy of clinical application.