作者：Patel, Ketan M. MD; Lin, Chih-Hung MD
文章發表：Plastic and Reconstructive Surgery: Volume 136 - Issue 4S - p 47–48
大綱：
腓骨皮瓣現在通常用於重建複合頜骨缺損。皮瓣執行的困難總是與骨骼取向和皮瓣插入的動態關係有關。傳統手術方向僅限於單支柱骨設計，以恢復下頜的連續性，而不恢復下頜的高度和輪廓。腓骨的完全嵌合允許常規使用雙層桿式的骨頭擺放設計來優化功能和美學效果。這項研究的目的是在重建下頜骨缺損的過程中嚴格評估這些技術。方法：回顧性研究2006-2013年由林志鴻醫師進行下頜骨重建的所有患者。所有患者均具有嵌合腓骨設計，並具有完全的後方纖維隔膜進行放鬆及分離。探討只有使用雙層技術進行下頜骨複合修復的患者。嚴格評估患者的人口統計學，手術技術和結果。
結果：在研究期間確定了59名患者。平均追蹤148週。 27％的患者使用了雙自由瓣。腓骨截骨術的平均數為1.9。每個骨段的平均長度為4.4cm。 7％的患者使用了雙皮瓣，其餘的使用了一個皮瓣。早期相關的再次手術發生在10％的患者中。沒有發生完全的皮瓣損失（0％）。 12％的患者發生部分皮瓣皮膚損失。三名患者（5％）經歷了與雙層擺放骨節段相關的併發症，需要重新手術。幾乎沒有發現主觀的患者抱怨，也沒有流口水的案例。總體而言，有34％的患者進行了與輪廓和/或鋼板去除相關的翻修手術。
結論：利用腓骨皮瓣的完全嵌合設計，可以為皮瓣植入選項提供更大的自由、雙層擺放技術更緊密地匹配下頜高度、以及降低與傳統方法相似的並發症發生率，利用這些現代技術可以改善功能和美容效果。
INTRODUCTION:
The fibula osteocutaneous flap is now commonly used to reconstruct composite mandibular defects. Difficulties in flap execution are invariably related to the dynamic relationship of the bone orientation and the skin paddle inset. Traditional design has been limited to a single-strut bony design in order to restore mandibular continuity, without restoration of mandibular height and contour. Full chimeric design of the fibula allows for the routine use of a double barrel strut to optimize functional and aesthetic outcomes. The purpose of this study was to critically evaluate these techniques during reconstruction of composite mandibular defects.
METHODS:
A retrospective review was conducted of all patients who underwent mandible reconstruction by the senior author (CHL) from 2006–2013. All patients had a chimeric fibula design, with a full posterior crural septum release and division. Only patients who underwent composite mandible reconstruction utilizing a double-barrel technique were isolated. Patient demographics, surgical techniques, and outcomes were critically evaluated.
RESULTS:
Fifty-nine patients were identified during the study period. Average follow-up was 148 weeks. A double free flap was utilized in 27% of patients. The average number of fibula osteotomies was 1.9. The average length of each bone segment was 4.4cm. A double skin paddle was utilized in 7% of patients, with the remainder utilizing a single skin paddle. Early perfusion-related re-operation occurred in 10% of patients. No complete flap losses occurred (0%). Partial paddle skin loss occurred in 12% of patients. Three patients (5%) experienced complications related to the barreled bone segment requiring re-operation. Few subjective patient complaints were found and no cases of drooling were documented. Overall, revision surgery related to contouring and/or plate removal occurred in 34% of patients.
CONCLUSION:
Utilizing a full chimeric design of the fibula osteocutaneous flap allows for greater degrees of freedom for flap insetting options. The double barrel technique more closely matches the mandibular height. With similar complication rates as traditional methods, utilizing these modern techniques may result in improved functional and cosmetic outcomes.
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