血管化游离腓骨瓣折叠后修复下颌骨缺损  

Repair of Mandibular defects using vascularized free fibular flap after folding

作　　者：周涛 赵方腾 姜垂广 邓达 孙京宇 钱永 ZHOU Tao;ZHAO Fangteng;JIANG Cuiguang(Department of Head and Neck Surgery,Hainan Cancer Hospital,Haikou,Hainan,570311,China)

机构地区：[1]海南省肿瘤医院头颈外科,海口570311

出　　处：《江西医药》2020年第11期1548-1551,共4页Jiangxi Medical Journal

基　　金：海南省重点研发计划资助项目,编号ZDYF2018173。

摘　　要：目的探讨血管化游离腓骨瓣折叠后修复下颌骨缺损的临床应用价值。方法回顾性研究我院头颈外科所开展的采用血管化游离腓骨瓣技术修复下颌骨缺损的18例患者。其中,11例(A组)采用单纯的单层腓骨瓣移植,7例(B组)将腓骨折叠成双层修复下颌骨缺损,以恢复下颌骨的正常高度。术中均使用血管吻合、坚强内固定等技术完成手术,并携带小块皮岛作为判断腓骨瓣血运的观察窗。结果两组18例患者平均随访29.7个月,成功率100%。A组患者中6例对进食、言语及吞咽等功能及8例对面部外形的恢复满意或较为满意,术后均未行二期种植牙修复;B组患者中5例对进食、言语及吞咽等功能及全部7例对面部外形满意或较为满意,有2例术后半年复诊拆除固定钛板并行二期种植牙修复,咀嚼功能恢复良好。两组所有患者均能正常行走,无踝关节不稳定症状;但两组各有1例患者诉长时间行走后患肢有酸胀不适症状。结论血管化游离腓骨瓣具有解剖恒定、供区血管条件好等优点为,而采用折叠技术克服其修复高度不足的缺点后,是目前下颌骨缺损修复重建的较好手段。Objective To investigate the clinical application value of folded vascularized free fibular flap in repairing mandible defects.Methods A retrospective study was conducted in 18 patients with mandibular defects repaired with vascularized free fibular flap in the Department of Head and Neck Surgery of our hospital.Among them,11 patients(group A)were treated with single-layer fibular flap transplantation alone,and mandibular defects of the other 7 patients(group B)were repaired using fibula folded into two layers to restore the normal height of the mandible.During the surgery,vascular anastomosis and rigid internal fixation were performed,and the carried small skin island was used as the observation window to determine the blood supply of fibular flap.Results Among the 18 patients,the average follow-up time was 29.7 months,and the success rate was 100%.In group A,6 patients were satisfied with eating,speech and swallowing function,and 8 patients were satisfied with the recovery of facial appearance.No secondary dental implant restoration was conducted after the surgery.In group B,5 patients were satisfied with eating,speech and swallowing functions,and all 7 patients were satisfied with the facial appearance.Two patients were followed up half a year after the surgery,and the fixed titanium plate was removed for secondary dental implant restoration,with masticatory function recovered well.All patients in the two groups were able to walk normally without ankle instability.However,one patient in each group complained of acid distension and discomfort of the affected limb after long walking.Conclusion The vascularized free fibular flap has the advantages of constant anatomy and good vascular conditions of donor site.It is the currently optimal way to repair and reconstruct mandible defects after overcoming insufficient repair height using folding technique.

关 键 词：下颌骨缺损 游离腓骨瓣 折叠 修复重建 

分 类 号：R782.4[医药卫生—口腔医学]