【摘要】 目的:探讨一种省时、省力的方法即刻修复保留髁状突的下颌骨及软组织的缺损。方法:对8例各种原因所致的下颌骨及周围软组织缺损(或不缺损)的患者,采用血管化腓骨肌皮复合组织瓣进行修复重建。制备的皮瓣既用来修复软组织缺损,又可作为“皮岛”观察腓骨的血供与回流状态。所切取的腓骨平均长度8.5cm,皮瓣或“皮岛”平均大小为6.5cm×3.5cm,形态为梭形。其中3例采用预制重建钛板进行塑形和固定,其余5例采用小钛板和16孔长钛板分段塑形固定。结果:所有皮瓣或“皮岛”全部成活,切口I期愈合,患者咬合关系正常,下颌功能与外形良好,行走无障碍。采用预制成型钛板进行塑形和固定的方法在手术用时上明显长于采用小钛板和16孔长钛板分段塑形固定的方法。结论:腓骨游离瓣可截成2～3段。截骨部位选择在颏体交界处和下颌角处。无论是2段还是3段截骨,采用预制成型钛板进行塑形和固定的手术用时明显长于采用小钛板和16孔长钛板分段塑形固定的方法。固定的顺序是先固定与髁状突或乙状切迹的连接处,确定咬合关系后,再分别固定下颌角、腓颏连接处和颏孔区。更多还原

【Abstract】 Objective:This article discusses a saved-time and strength method with the vascularized fibula free combined flap for instant mandible retained condyle and corresponding soft tissue reconstruction.This method is based on our clinical experience.Methods: 8 patients suffering from combined mandibular defect because of series of reasons were chosen.Combined vascularized fibula free flap for instant mandible retained condyle and corresponding soft tissue reconstruction was performed.The skin paddle(skin island) of the osteocutanous flap was based on the perforators and used to repair mucosal or skin defect,or as an external"monitor",which was shuttle-shaped.The average value of the fibula length is 8.5cm and the average value of surface area of skin paddle(skin island) is 6.5cm×3.5cm.The fibulas were shaped and fixed with long prefabricated titanium plate on 3 patients and with segmented mini-plate/16-holed titanium plate on the rest patients.Results: All flaps survived well without failure except one.All patients had well-incisions,good occlusion,mandibular normal activity and symmetric appearance.But the lasting time of using long prefabricated titanium plate is longer than that of using segmented mini-plate/16-holed titanium plate.Conclusions:Combined vascularized fibula free flap can cut into 2~3 segments based on the mandibular shape and occlusion,shaping and fixation using segmented mini-plate/16-holed titanium plate make the procedure easier and safer.It is advised that the fixation sequence is firstly condyle,secondly the angle and next the mental foreman area and the connection between the fibula and the chin.更多还原