腓骨瓣再造下颌骨时血管蒂的位置及吻合方法

目的：探讨腓骨瓣再造下颌骨时血管蒂的摆放及吻合方法。方法：自１９９６年４月以来，应用腓骨（皮）瓣修复下颌骨缺损２６例。按下颌骨术后缺损范围，将其分为八类。根据每类的特点，提出血管蒂的放置，受区血管选择及吻合方法。结果：２６例腓骨（皮）瓣全部存活。血管蒂长度在４～８ｃｍ；受区动脉大多数选用颌外动脉（１９例），少数选用甲状腺上动脉（７例）；受区静脉选用面静脉９例，颈外静脉１７例。２３例为近心端腓血管与受区血管吻合，３例为逆行吻接。结论：不论下颌骨缺损类型如何，血管蒂必须置于新建下颌骨下缘或内面，并千方百计靠近受区血管，以确保吻合成功

PLACEMENT OF THE VASCULAR PEDICLE AND METHODS OF VASCULAR ANASTOMOSIS IN RECONSTRUCTION OF MANDIBULAR DEFECTS WITH FIBULAR FREE FLAP

Objective To evaluate the placement of the vascular pedicle and methods of vascular anastomosis of fibula free flap for mandibular reconstruction. Methods 26 cases with oro mandibular defects were reconstructed with fibula free flaps without failure from April, 1996. The defects were classified into 8 types according to the resected extent. On the basis of each type's feature, the methods of pedicle placing, recipient vessel selection and vascular anastomosis were discussed. Results All the revascularized flaps survived with a success rate of 100%. The lengths of vascular pedicles were 4-8cm. The recipie.nt arteries were facial arteries in 19 cases, and supero thyroid arteries in 7 cases; Facial vein and external jugular vein were chosen as recipient vein in 9 cases and 17 cases, respectively. 23 fibula flaps were based on the proximal peroneal artery, 3 were transferred based on retrograde peroneal artery flow. Conclusions We believe that the vascular pedicle must be placed at the lower border or the internal side of the neo mandible and close to the recipient vessels as much as possible to assure the success of the operation, whatever the types of the mandible defects are.