Lateral segmental mandibulectomy reconstruction with bridging reconstruction plate and anterolateral thigh free flap: a case series of 30 consecutive patients
Lateral segmental mandibulectomy reconstruction with bridging reconstruction plate and anterolateral thigh free flap: a case series of 30 consecutive patients
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DOI：
10.1016/j.bjoms.2020.08.054
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发表时间：
2021-01-01
影响因子：
1.8
通讯作者：
Bisase, B.
中科院分区：
文献类型：
--
作者：
Bowe, C.;Butler, D.;Bisase, B.
下颌骨后外侧节段性缺损的修复是一个挑战，骨瓣是修复此类缺损的金标准。然而，结合下颌骨重建板（MRP）和软组织游离皮瓣，（恢复粘膜完整性并提供接骨板本身的持久覆盖）为不适合骨重建的患者的后节段下颌骨缺损提供了替代选择，我们回顾性分析了30例连续的患者，（19名男性和11名女性），他们接受了使用桥接MRP和股前外侧（ALT）游离皮瓣重建下颌骨节段性切除术缺损。平均（范围）年龄为67（31-87）岁。研究人群的美国麻醉医师协会（阿萨）状态包括1级（n = 10）、2级（n = 18）和3级（n = 2）。大多数患者患有口腔鳞状细胞癌（n = 26），累及下颌骨，2例患有放射性骨坏死，2例患有粘液表皮样癌。4例患者发生了重建特定的并发症，1例发生了皮瓣丢失（成功率为96.7%）。3例发生金属制品感染，包括1例钢板挤压和1例钢板断裂。中位住院时间为10天，平均（范围）随访时间为23.3（1-96）个月。这项技术是一种替代重建的选择无牙轴承下颌骨。用桥接MRP和ALT游离皮瓣重建后外侧下颌骨节段切除术缺损提供了一种可靠的重建方法，并发症少。(C)2020年英国口腔颌面外科医生协会。由爱思唯尔有限公司出版。保留所有权利。
Lateral posterior segmental mandibular defects present a reconstructive challenge and an osseous flap would be the gold standard to reconstruct such a defect. However, combining a mandibular reconstruction plate (MRP) with a soft-tissue free flap (to restore mucosal integrity and provide durable coverage of the plate itself) offers an alternative option for posterior segmental mandibular defects in patients who are not suitable for osseous reconstruction, or do not choose it. We retrospectively reviewed 30 consecutive patients (19 male and 11 female) who underwent reconstruction of a segmental mandibulectomy defect using a bridging MRP and anterolateral thigh (ALT) free flap. The mean (range) age was 67 (31-87) years. The American Society of Anesthesiologists' (ASA) status of the study population comprised Grade 1 (n = 10), Grade 2 (n = 18), and Grade 3 (n = 2). The majority of patients had oral cavity squamous cell carcinoma (n = 26) involving the mandible, two had osteoradionecrosis, and two mucoepidermoid carcinoma. Four patients had complications specific to the reconstruction, and flap loss occurred in one (96.7% success rate). Metalwork infection occurred in three, including one plate extrusion and one plate fracture. The median length of stay was 10 days, and mean (range) duration of follow up 23.3 (1-96) months. This technique is an alternative reconstructive option for the non-tooth-bearing mandible. Reconstructing a posterolateral segmental mandibulectomy defect with a bridging MRP and ALT free flap offers a robust reconstructive alternative with a favourable complication profile. (C) 2020 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.