小腿外侧复合组织瓣移植修复口腔颌面肿瘤切除后的缺损

目的评价小腿外侧复合组织瓣移植修复口腔颌面肿瘤切除后缺损的临床应用价值. 方法 1999年11月～2002年12月,对28例口腔颌面部肿瘤患者术后应用小腿外侧复合组织瓣游离移植,修复骨及软组织缺损.手术采用血管吻合、单叶皮瓣和坚固内固定等恢复口腔颌面缺损器官的形态及完整性.其中21例为带腓骨的腓骨皮瓣移植,7例为携带肌肉的腓骨肌皮瓣移植.采用游离小腿外侧皮瓣,大小3.0 cm×5.5 cm～8.0 cm×12.0 cm,腓骨长度5.5～16.0 cm.有3例同期植入种植体共5枚. 结果术后24例成功,3例部分皮瓣坏死,1例肌皮瓣坏死.3例同期植入的5枚种植体均达到良好的骨整合效果,并已行上部义齿修复.26例获随访1～36个月,平均18.5个月,23例患者面部外形恢复、张闭口及语音功能达到满意或较满意. 结论小腿外侧复合组织瓣有充足的可供取用的组织量,尤其是对同时伴有大量骨缺损患者.且具备血管蒂长、管径粗、易于吻合,以及供区隐蔽等优点,是修复重建口腔颌面部软硬组织缺损可选择的方法之一.

REPAIR OF ORAL MAXILLOFACIAL DEFECT WITH FREE PERONEAL COMPOSITE FLAP

OBJECTIVE: To evaluate the advantages and disadvantages of vascularized free peroneal composite flaps for reconstruction of oral and maxillofacial defects. METHODS: From November 1999 to December 2002, 28 cases of oral maxillofacial defects were reconstructed with vascularized free peroneal composite flaps, with fibula-cutaneous flap in 21 cases and with fibula-myocutaneous flap in 7 cases. Three cases received insertion of dental implants into the fibula flap. The flap size was 3.0 cm x 5.5 cm to 8.0 cm x 12.0 cm; the fibula length was 5.5 cm to 16.0 cm. RESULTS: Of the 28 flaps reconstructed, 24 survived, 3 necrosed partially and 1 necrosed completely. All the 5 implants survived and achieved good bone integration in 3 cases. Twenty-six cases were followed up 1-36 months with an average of 18.5 months, the facial appearance and the vocal function were satisfactory in 23 cases. CONCLUSION: Vascularized peroneal flap has many advantages and is one of the optimal flaps for reconstruction of oral maxillofacial defects.