【摘要】 目的:总结应用腓骨肌皮瓣游离移植对颌面部软硬组织缺损的功能重建的临床经验。方法:自2007～2011年7月,我科应用腓骨肌皮瓣一期修复下颌骨及周围软组织缺损11例,其中男性8例,女性3例,年龄33～67岁,其中左下颌牙龈鳞癌4例,右下颌牙龈鳞癌2例,右舌下腺腺样囊性癌1例,右口底鳞癌2例,左下颌黏液表皮样癌1例,成釉细胞瘤1例。其中磨牙后区粘液表皮样癌和成釉细胞瘤2例进行即刻种植。受区血管均为同侧,组织瓣均吻合1根动脉、2根静脉。动脉选用颈外动脉分支,静脉选用面总静脉、颈前静脉或颈外静脉,所有动静脉吻合均采用端端吻合法。分析皮岛的设计、大小、修复部位、存活情况等。结果:本组游离腓骨肌皮瓣11例全部成活,均携带1块皮岛,由一个穿支供养,皮岛最大6cm×4cm,最小3cm×2cm,皮岛均用于口内软组织缺损修复,2例即刻种植植入种植体6颗。术后面部外形、功能及咬合关系良好。语音功能基本正常。下肢功能在术后3～6个月恢复正常。结论:腓骨瓣的骨量充足,具有骨膜和骨髓双重血供,血运丰富,抗感染能力强,移植后易于成活。可根据需要做多段截骨塑形从而更加准确的恢复颌骨牙槽突形态。操作过程中远离头颈部,可以双组同时手术。腓骨的高度和宽度以及皮质骨的厚度也十分适合牙种植体的植入。游离腓骨瓣的皮岛不仅可用于口内外的软组织缺损修复,还可作为术后血供的观察窗。腓骨肌皮瓣在修复颌面部软硬组织缺损中具有血供安全可靠,塑形灵活,模拟外形准确,利于监测,并发症少等优点,是能够同时兼顾颌骨缺损及周围软组织缺损修复重建的理想方法。更多还原

【Abstract】 Objective: To summarize clinical experiences of reconstruction of maxillofacial defect using vascularized fibular free flaps with implants immediately placed.Methods: Data of eleven patients,aged 33 years to 67 years,with maxillofacial defect undergoing reconstruction using vascularized fibular free flaps were analyzed.Of those 11patients,8 was squamous cell carcinoma(4 left mandible gum,2 right mandible gum and 2 mouth floor),1 was adenoid cystic carcinoma of right sublingual gland,1 was mucus epidermoid cancer of left mandible gum and 1 was adamantoblastoma.Results: Microvascular fibula transfers were completely successful,and all skin paddles survived without necrosis.In our cases,the paddles were harvested corresponding to the size of the mandibular defect.Prosthodontic treatment was completed in 2 patients with 6 implants implanted.In our cases,the oral function after reconstructive surgeries with the fibula osteoseptocutaneous flap was acceptable.Furthermore,the patients could walk without difficulty in 3 to 6 months.Conclusion: The vascularized free fibula flap has become one the most popular reconstruction methods after mandibular resection because of adequate bone graft length,easy contour achieving and antiinfection due to its reliable vascularization.更多还原