Mandibular reconstruction using microvascular free flaps: A statistical analysis of 178 cases
Mandibular reconstruction using microvascular free flaps: A statistical analysis of 178 cases
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DOI：
10.1097/00006534-200111000-00018
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发表时间：
2001-11-01
影响因子：
3.6
通讯作者：
Kimata, Y
中科院分区：
文献类型：
--
作者：
Takushima, A;Harii, K;Kimata, Y
本文对1979年至1997年178例应用微血管游离皮瓣重建下颌骨的病例进行了研究。本报告的目的是比较皮瓣的成功率，并发症，美学和功能的结果。131名男性和47名女性的年龄从13岁到85岁不等，平均55岁。供区包括肋骨11例、桡骨1例、髂骨36例、肩胛骨51例、腓骨34例和带植入物的软组织瓣45例。并发症包括皮瓣全部坏死、部分坏死、大瘘形成和小瘘形成。髂骨、腓骨皮瓣坏死率明显高于其他材料的皮瓣坏死率（P < 0.05）。由于接骨板暴露或断裂导致的种植体接骨板移除的总比率为35.6%（45例中的16例）。根据Jewer等人的HCL方法对下颌骨缺损的程度进行分类。将软组织缺损的程度分为四组：无缺损、皮肤缺损、粘膜缺损和穿透性缺损。根据这些分类，吞咽和轮廓的功能和美学评估进行了115名受试者，并在110语音进行了评估。为了评价术后结果，对吞咽、言语和下颌轮廓的每项评估进行评分。骨缺损组对之间的统计学分析显示，在每个类别中没有显着差异。关于吞咽，对软组织缺损组之间的统计学分析显示，无缺损组与粘膜缺损组之间以及无缺损组与贯通缺损组之间存在显著差异（P < 0.05）。在言语方面，无穿孔组和穿孔组之间存在显著差异（p < 0.05）。在外形方面，无和穿透组之间以及粘膜和穿透组之间存在显著差异（p < 0.01）。根据重建材料的不同，每个功能的得分显示，材料组对之间没有显著差异。从这项前瞻性研究中，作者开发了一种用于口下颌骨重建的算法。当骨缺损位于外侧时，应根据软组织缺损的程度选择髂骨、腓骨或肩胛骨作为供区。当骨缺损位于前方时，腓骨始终是最佳选择。当软组织缺损广泛或穿透性，并伴有前部骨缺损时，腓骨应与其他软组织瓣一起使用。
For this article, 178 consecutive cases of mandibular reconstruction using microvascular free flaps and performed from 1979 to 1997 were studied. The purpose of this report is to compare flap success rates, complications, and aesthetic and functional results. The ages of the 131 men and 47 women ranged from 13 to 85 years, with an average of 55 years. Donor sites included the rib (11 cases), radius (one case), ilium (36 cases), scapula (51 cases), fibula (34 cases), and soft-tissue flaps with implant (45 cases). Complications included total flap necrosis, partial flap necrosis, major fistula formation, and minor fistula formation. The rate of total flap necrosis involving the ilium and fibula was significantly higher than that of all other materials combined (P < 0.05). The overall rate of implant plate removal, which resulted from the exposure or fracture of the plate, was 35.6 percent (16 of 45 cases).Each mandibular defect was classified by the extent of the bony defect and by the extent of the soft-tissue defect. The extent of the mandibular bony defect was classified according to the HCL method of Jewer et al. The extent of the soft-tissue defect was classified into four groups: none, skin, mucosal, and through-and-through. According to these classifications, functional and aesthetic assessments of deglutition and contour were performed on 115 subjects, and speech was evaluated in 110. To evaluate the postoperative results, points were assigned to each assessment of deglutition, speech, and mandibular contour. Statistical analysis between pairs of bone-defect groups revealed that there was no significant difference in each category. Regarding deglutition, statistical analysis between pairs of soft-tissue-defect groups revealed there were significant differences (P < 0.05) between the none and the mucosal groups and also between the none and the through-and-through groups. Regarding speech, there was a significant difference (p < 0.05) between the none and the through-and-through groups. Regarding ontour, there were significant differences (p < 0.01) between the none and the through-and-through groups and between the mucosal and the through-and-through groups. The points given for each function, depending on the reconstruction material, revealed that there was no significant difference between pairs of material groups.From this prospective study, the authors have developed an algorithm for oromandibular reconstruction. When the bony defect is lateral, the ilium, fibula, or scapula should be chosen as the donor site, depending on the extent of the soft-tissue defect. When the bony defect is anterior, the fibula is always the best choice. When the soft-tissue defect is extensive or through-and-th rough with an anterior bony defect, the fibula should be used with other soft-tissue flaps.