Chen HH, Qiu SS, Lin CH, Kang CJ, Liao CT
Annals of Plastic Surgery. 77(6):635–639, DECEMBER 2016
摘要
自1975年首次文獻發表以來，皮下骨質腓骨皮瓣已被廣泛用於骨頭和軟組織的重建。如今，由於其對下頜骨重建的適應性，該骨皮瓣已成為頭頸部重建的主要顏面骨重建。然而，此骨皮瓣的可靠性仍然存在爭議。我們描述了一種用於摘取骨皮瓣的改進方法，以獲得更可靠的骨皮瓣，同時最小化供應部位的發病率。
從2005年1月至2013年12月，共有152名患者參加了本研究。所有患者均接受了頭頸部（n = 135）或肢體（n = 16）重建的游離骨皮瓣並持續追蹤，收集所有患者的人口統計學數據：年齡，性別，缺陷位置和病因。用於統計分析的變量是：皮膚皮瓣的大小，摘取時間，再次手術，以及骨頭植入的單支橫放或疊放方式，測量的結果是皮瓣成功率和皮瓣存活率。
皮瓣成功率為97.3％。平均提取時間為45分鐘。皮膚皮瓣的平均寬度和長度分別為7.1±2.6和17.41±4.4cm。這些患者的皮瓣重新探查率為18.5％，搶救率達到85.7％。在13.2％的病例中發現部分皮膚皮瓣壞死。事實發現在術後期間重新探查是與皮膚皮瓣壞死顯著相關的唯一變量（P = .001）。
根據我們的經驗，從後路摘取皮下骨質腓骨皮瓣是一種安全的技術，並提供許多優點，例如於臨床上有更好的視野，有利於將嵌合皮瓣抬高，保護供體部位的肌肉筋膜，以及任何解剖變異的早期診斷。通過這種方法，皮瓣的可靠性和多功能性都可以大大提高。
The osteoseptocutaneous fibula flap has been widely used for bone and soft tissue reconstruction from its first description in 1975. Nowadays, this flap has become the workhorse flap for head and neck reconstruction because of its suitability for mandible reconstruction. However, the reliability of the skin paddle is still controversial. We described a modified method for the harvesting of an osteoseptocutaneous flap to obtain a more reliable skin paddle while minimizing the donor site morbidity.
One hundred fifty-one consecutive patients were enrolled in the current study from January 2005 to December 2013. All of them underwent a free osteoseptocutaneous flaps for either head and neck (n = 135) or extremity (n = 16) reconstruction following the posterior approach harvest technique. Demographics data of all the patients were collected: age, sex, defect location, and etiology. The variables included for the statistical analysis were: size of the skin paddle, time of harvesting, reoperation, split skin paddle, and single or double barrel fashion for the inset. The outcomes measured were the flap success rate and the skin paddle survival.
The flap success rate was 97.3%. The mean harvesting time was 45 minutes. The mean width and length of the skin paddle was 7.1 ± 2.6 and 17.41 ± 4.4 cm, respectively. The reexploration rate was 18.5%, and the salvage was achieved 85.7% of the cases. Partial skin paddle necrosis was found in 13.2% of the cases. The fact of having a reexploration in the postoperative period was the only variable significantly associated with the skin paddle necrosis (P = .001).
According to our experience, the posterior approach for the harvest of the osteoseptocutaneous fibula flap is a safe technique and offers many advantages, such as a better visualization of the perforators, beneficial for chimeric flap elevation, preservation of the muscular fascia in the donor site, and an earlier diagnosis of any anatomical variation. Both the reliable and the versatility of the skin paddle can substantially improve with this approach.
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