Functional Outcomes of Fibula and Osteocutaneous Forearm Free Flap Reconstruction for Segmental Mandibular Defects
Functional Outcomes of Fibula and Osteocutaneous Forearm Free Flap Reconstruction for Segmental Mandibular Defects
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DOI：
10.1002/lary.20791
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发表时间：
2010-04-01
期刊：
影响因子：
2.6
通讯作者：
Rosenthal, Eben L.
中科院分区：
文献类型：
--
作者：
Virgin, Frank W.;Iseli, Tim A.;Rosenthal, Eben L.
目的/假设：证明前臂桡侧骨皮游离瓣在下颌骨重建中与腓骨游离瓣相比可提供同等的功能结果并改善发病率。研究设计：回顾性综述方法：2001年1月至2008年12月期间，有168名患者需要游离瓣重建节段性下颌骨缺损。平均随访时间腓骨游离皮瓣（FFF）（n = 117）为31个月，前臂桡侧骨皮游离皮瓣（OCRFFF）（n = 51）为20个月，反映：前臂的使用越来越多。大多数（96.2%）重建为恶性病变。腓骨组皮瓣失败率为3.4%，前臂组为3.9%。畸形愈合不常见（2.0% OCRFFF，6.0% FFF，P = 0.26）。FFF组的供体部位并发症（4.3%）高于OCRFF组（P = 0.13）。尽管这一患者人群的长期生存率很高，（癌症5年时为75%），很少植入牙科种植体（2.3%的患者），前臂比腓骨游离皮瓣更常见。功能结局显示，两组之间在口服饮食方面没有显著差异。（FFF 72.6% vs OCRFFF 79.1%，P = 0.49）或保留胃肠营养管（20.9% OCRFFF vs. 27.4% FFF，P = .49）结论：前臂桡侧骨皮瓣在下颌骨节段切除术中的功能效果与腓骨游离皮瓣相当，缺陷总体的牙种植率较低，与腓骨瓣相比，前臂桡侧骨皮瓣更常见。
Objective/Hypothesis: To demonstrate that the osteocutaneous radial forearm free flap provides equivalent functional outcomes and improved morbidity compared to the fibular free flap in mandibular reconstruction.Study Design: Retrospective reviewMethods: There were 168 patients requiring free flap reconstruction of segmental mandibular defects between January 2001 and December 2008. Mean follow-up was 31 months for fibula free flap (FFF) (n = 117) and 20 months for osteocutaneous radial forearm free flaps (OCRFFF) (n = 51), reflecting : an increasing use of forearms.Results: OCRFFF were more commonly used in older patients (mean 63.7 years vs. 59 years, P =.03). The majority (96.2%) of reconstruction was for malignant pathology. Flap failure was 3.4% for the fibula group and 3.9% in the forearm group. Malunion was infrequent (2.0% OCRFFF, 6.0% FFF, P = .26). Donor site complications were higher in the FFF group (4.3%) versus none in the OCRFF group (P = .13). Despite a high rate of long-term survival in this patient population (75% at 5 years for carcinoma), dental implants were rarely placed (2.3% of patients) and were more common in forearm than fibula free flaps Functional outcomes demonstrated no significant difference between groups with respect to oral diet (FFF 72.6% vs OCRFFF 79.1%, P = .49) or retained enterogastric feeding tube (20.9% OCRFFF vs. 27.4% FFF, P = .49)Conclusions: Osteocutaneous radial forearm flaps provide comparable functional outcomes with less morbidity compared to fibula free flaps for selected segmental mandibulectomy defects. The overall dental implantation rate was low and more commonly performed in osteocutaneous radial forearm flaps compared to fibula flaps.