作者：Chih-Hung Lin;Chun-Ta Liao;Cheng-Hung Lin;Bien-Keem Tan;Chun-Ta Lee
文章發表：Annals of Plastic Surgery. 74():S152–S157, MAY 2015
大綱：在使用腓骨瓣進行下牙齦癌的重建後，發生骨頭無法融合、慢性骨髓炎或腓骨骨暴露的情況並不少見，這需要對骨骼和軟組織進行複合重建。因前臂橈骨皮瓣具有應力性骨折的風險，故前臂尺側骨皮瓣可以為小骨缺損重建的另一種選擇。方法：進行過腓骨皮瓣下頜骨重建術並持續骨暴露（3例），慢性骨髓炎（1例），牙齒錯位合畸形（1例）或骨放射性壞死（1例）的6例患者接受了尺骨前臂3-cm尺骨骨皮瓣進行補強性重建手術，橈尺遠側關節用螺釘融合，還對4具新鮮的冷凍屍體進行了6次尺前臂骨皮瓣的解剖，以闡明尺骨遠端動脈的解剖分佈。結果：所有6個尺前臂骨皮瓣均存活，其中1例經靜脈閉塞重新打開探查。全部案例均有骨頭癒合。與臨床解剖相比，屍體尺骨遠端動脈顯示出一條骨膜分支，在尺神經和背側感覺神經分板之間延伸。該骨膜分支是從尺腕動脈近腕關節近3 cm處出來。。
結論：尺骨前臂骨皮瓣可為腓骨皮瓣轉移後的特定下頜骨缺損提供皮瓣和小節段骨的繼發皮瓣。
It is not uncommon that after using a fibular flap for lower gum cancer reconstruction, nonunion, chronic osteomyelitis, or fibular bone exposure occurs, which requires a composite bone and soft tissue reconstruction. Radial forearm osteocutaneous flap possesses the risk of stress fracture. Ulnar forearm osteocutaneous flap can be another option for small bone defect reconstruction.
PATIENTS AND METHOD:
Six patients who had undergone fibular flap for mandible reconstructions and sustained either bone exposure (3 patients), chronic osteomyelitis (1 patient), malocclusion (1 patient), or osteoradionecrosis (1 patient) underwent ulnar forearm osteocutaneous flap with 3-cm ulnar bone for touch-up procedure. The distal radioulnar joints were fused with a screw. Six ulnar forearm osteocutaneous flap dissections were also performed on 4 fresh frozen cadavers to clarify the anatomic distribution of the distal ulnar artery.
RESULT:
All 6 ulnar forearm osteocutaneous flaps survived with one re-exploration for venous occlusion. All presented bone union. Comparable to the clinical dissection, the cadaveric distal ulnar artery demonstrates a periosteal branch that runs between the proper ulnar nerve and dorsal sensory nerve. This periosteal branch comes out of an ulnar artery approximately 3 cm proximal to the wrist joint.
CONCLUSION:
Ulnar forearm osteocutaneous flap can provide a secondary flap of wide skin paddle and small segment bone for specific mandibular defect after a fibular flap transfer.
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