Double-barrel vascularised fibula graft in mandibular reconstruction: A 10-year experience with an algorithm
Double-barrel vascularised fibula graft in mandibular reconstruction: A 10-year experience with an algorithm
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DOI：
10.1016/j.bjps.2012.10.005
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发表时间：
2013-03-01
影响因子：
2.7
通讯作者：
Ow, Andrew
中科院分区：
文献类型：
--
作者：
Shen, Yi;Guo, Xue-hua;Ow, Andrew
背景资料：本回顾性研究的目的是报告一种算法，以帮助外科医生在选择不同模式的双桶血管化腓骨移植下颌reconstruction. Methods：共45例接受重建下颌骨缺损与不同模式的双桶血管化腓骨移植进行了审查。我们的算法，以决定任何一个不同的模式，不同的下颌骨缺损的影响因素，包括放射治疗的历史，下颌骨体缺损的长度和需要保留下颌骨下缘。术后功能结果包括术后2年获得的饮食类型和言语以及美学结果。对种植义齿患者进行咀嚼功能评估。结果：根据我们的方法，有四种下颌骨重建模式，包括双筒腓骨移植（n = 21），部分双筒腓骨移植（n = 11），髁状突假体联合部分/双筒腓骨移植（n = 11），双筒腓骨覆盖移植2例。皮瓣成活率为97.78%。在44例患者中观察到良好的咬合、骨愈合和伤口闭合。11例患者于术后9-18个月在移植腓骨内植入牙种植体。1例患者戴可摘局部义齿。11例种植义齿患者术后同侧咬合力平均为对侧咬合力的41.5 ± 17.7%。随访2年以上的38例患者均取得了良好的功能和美学效果，包括饮食正常，言语正常，外观优良或良好，特别是对牙齿康复的患者。结论：根据我们的算法选择不同的双筒血管化腓骨移植重建下颌骨，可以在牙齿康复后获得良好的美学和功能效果。(C)2012年英国整形、重建和美容外科医生协会。由爱思唯尔有限公司出版。保留所有权利。
Background: This retrospective study aims to report an algorithm to assist surgeons in selecting different modes of the double-barrel vascularised fibula graft for mandibular reconstruction.Methods: A total of 45 patients who underwent reconstruction of mandibular defects with different modes of the double-barrel vascularised fibula graft were reviewed. Our algorithm for deciding on any one of the different modes for different mandibular defects is influenced by factors including history of radiotherapy, the length of mandibular body defect and the need to preserve the inferior mandibular border. Post-operative functional outcomes included diet type and speech, and aesthetic results gained at post-operative 2 years. Patients with implant-borne prosthetic teeth underwent assessment of their masticatory function.Results: There were four modes of mandibular reconstruction according to our algorithm, which included double-barrel vascularised fibula graft (n = 21), partial double-barrel fibula graft (n = 11), condylar prosthesis in combination with partial/double-barrel fibula graft (n = 11), and double-barrel fibula onlay graft (n = 2). Flap survival in all patients was 97.78%. Good occlusion, bony unions and wound closures were observed in 44 patients. Eleven patients received dental implantation in the transplanted fibula at post-operative 9-18th months. One patient wore removal partial dentures. For 11 patients with implant-borne prosthetic teeth, the average post-operative ipsilateral occlusal force was 41.5 +/- 17.7% of the contralateral force. Good functional and aesthetic results were achieved in 38 patients with more than 2 years of follow-up, including regular diet, normal speech and excellent or good appearance, especially for patients with dental rehabilitation.Conclusion: Good aesthetic and functional results can be achieved after dental rehabilitation by following our algorithm when choosing the different modes of double-barrel vascularised fibula graft for mandibular reconstruction. (C) 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.