Reconstruction of the mandible with osseous free flaps: A 10-year experience with 150 consecutive patients
Reconstruction of the mandible with osseous free flaps: A 10-year experience with 150 consecutive patients
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DOI：
10.1097/00006534-199910000-00011
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发表时间：
1999-10-01
影响因子：
3.6
通讯作者：
Hu, QY
中科院分区：
文献类型：
--
作者：
Cordeiro, PG;Disa, JJ;Hu, QY
游离骨瓣已成为修复下颌骨节段性缺损的首选方法。在457例头颈部游离皮瓣中，150例在10年内进行了下颌骨重建。本研究回顾性分析了94例男性和56例女性患者（平均年龄50岁，范围3 ~ 79岁）的下颌骨缺损，43%的患者有半侧下颌骨缺损，其余的患者有中央缺损、侧部缺损或合并缺损。供体部位包括腓骨（90%）、桡骨（4%）、肩胛骨（4%）和髂骨（2%）。98%的患者使用刚性固定（最多5个截骨部位）。术后至少6个月对美学和功能结果进行评估，游离皮瓣成功率为100%，截骨部位骨愈合率为97%。20例患者植入骨结合种植体。45%的患者恢复了无限制的饮食; 45%恢复了软食，5%恢复了流质饮食。5%的患者需要肠道喂养来维持体重。言语被评估为正常（36%），接近正常（27%），可理解（28%）或不可理解（9%）。美学效果被评定为优（32%）、良（27%）、一般（27%）或差（14%）。本研究表明，使用骨游离瓣进行初次下颌骨重建的成功率非常高，功能和美学效果从好到优。腓骨供区应是大多数病例的首选，特别是那些需要多次截骨的前部或大面积骨缺损的病例。使用替代供体部位（即，桡骨和肩胛骨）最好保留用于具有大软组织和最小骨需求的病例。只有在其他选择不可用时，才建议使用髂骨。在大多数情况下，正确的皮瓣选择和设计应该取代多个同时进行的游离皮瓣和静脉移植的需要。
Osseous free flaps have become the preferred method for reconstructing segmental mandibular defects. Of 457 head and neck free flaps, 150 osseous mandible reconstructions were performed over a 10-year period. This experience was retrospectively reviewed to establish an approach to osseous free flap mandible reconstruction.There were 94 male and 56 female patients (mean age, 50 years; range 3 to 79 years); 43 percent had hemimandibular defects, and the rest had central, lateral, or a combination defect. Donor sites included the fibula (90 percent), radius (4 percent), scapula (4 percent), and ilium (2 percent). Rigid fixation (up to five osteotomy sites) was used in 98 percent of patients. Aesthetic and functional results were evaluated a minimum of 6 months postoperatively.The free flap success rate was 100 percent, and bony union was achieved in 97 percent of the osteotomy sites. Osseointegrated dental implants were placed in 20 patients. A return to an unrestricted diet was achieved in 45 percent of patients; 45 percent returned to a soft diet, and 5 percent were on a liquid diet. Five percent of patients required enteral feeding to maintain weight. Speech was assessed as normal (36 percent), near normal (27 percent), intelligible (28 percent), or unintelligible (9 percent). Aesthetic outcome was judged as excellent (32 percent), good (27 percent), fair (27 percent), or poor (14 percent).This study demonstrates a very high success rate, with good-to-excellent functional and aesthetic results using osseous free flaps for primary mandible reconstruction. The fibula donor site should be the first choice for most cases, particularly those with anterior or large bony defects requiring multiple osteotomies. Use of alternative donor sites (i.e., radius and scapula) is best reserved for cases with large soft-tissue and minimal bone requirements. The ilium is recommended only when other options are unavailable. Thoughtful flap selection and design should supplant the need for multiple, simultaneous free flaps and vein grafting in most cases.