Midface reconstruction with the fibula free flap
Midface reconstruction with the fibula free flap
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DOI：
10.1001/archotol.128.2.161
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发表时间：
2002-02-01
影响因子：
--
通讯作者：
Farwell, DG
中科院分区：
文献类型：
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作者：
Futran, ND;Wadsworth, JT;Farwell, DG
目的：评价腓骨游离骨皮瓣在面中部重建中的应用、适应证和效果。设计：病例系列回顾。地点：第三转诊中心。患者：我们评估了1994年1月1日至2000年1月1日所有需要面中部肿瘤切除后重建的患者。27例缺乏足够的固位表面和/或牙齿来支撑传统假体的患者接受了带血管蒂骨重建。干预：所有患者接受了面中部的腓骨游离骨皮瓣重建：一期16例，二期11例。主要观察指标：游离组织移植成功，围手术期并发症，口腔饮食，言语，牙齿重建类型，美容。结果：27个皮瓣中26个成活。4例患者伤口并发症在局部伤口护理下处理成功。14例患者实现了有规律的饮食，13例患者保持了软饮食。18名患者植入了骨整合种植体，14名患者使用了种植假体。美容效果优14例，良8例，可4例，差1例。结论：应用腓骨游离骨皮瓣重建面中部是一种非常可靠的方法，是修复上颌骨下部组织缺损的首选方法。然而，当眶-颧骨支撑为主要目的时，该皮瓣的使用受到限制。由于这一过程的复杂性，面中部重建技术的选择应针对每个患者的个体化。
Objective: To evaluate the use, indications, and outcomes of the fibula osteocutaneous free flap when reconstructing the midface.Design: Retrospective review of a case series.Setting: Tertiary referral center.Patients: We evaluated all patients requiring midface reconstruction after tumor resection between January 1, 1994, and January 1, 2000. Twenty-seven individuals who lacked sufficient retentive surfaces and/or teeth to support a conventional prosthesis were offered vascularized bony reconstruction.Interventions: All patients underwent fibular osteocutaneous free flap reconstruction of the midface: 16 primarily, 11 secondarily.Main outcome Measures: Success of free tissue transfer, perioperative complications, oral diet, speech, type of dental reconstruction, and cosmesis.Results: Twenty-six of 27 flaps survived. Four patients had wound complications managed successfully with local wound care. Fourteen patients achieved a regular diet and 13 patients maintain a soft diet. Eighteen patients had osseointegrated implants placed, and 14 patients used an implant-borne prosthesis. Cosmetic results were judged to be excellent in 14 patients; good in 8; fair in 4; and poor in 1.Conclusions: Use of the fibula osteocutaneous free flap to reconstruct the midface is highly reliable and our flap of choice for lower maxillary defects requiring bony reconstruction. However, when orbitozygomatic support is the primary objective, the utility of this flap is limited. Because of the complexity of this procedure, the choice of midface reconstruction technique should be individualized for each patient.