不同类型血管化游离腓骨瓣修复下颌骨缺损的回顾性分析

doi:10.3969/j.issn.1005-4979.2023.02.008

摘要/Abstract

摘要：

目的：探讨利用血管化游离腓骨瓣（free fibular flap, FFF）重建面下1/3软硬组织缺损的方法，评价利用腓骨瓣修复下颌骨缺损的多样性及灵活性。方法：收集因良、恶性肿瘤行下颌骨节段性切除同期行腓骨瓣修复的患者35例，统计患者下颌骨缺损类型、术前设计、腓骨瓣修复方法及携带皮岛的情况。结果：根据COM分类法进行分类，Ⅰ类6例、Ⅱ类26例、Ⅲ类3例，缺损长度为4.85~17.00 cm，平均（8.29±2.69）cm。单层腓骨瓣修复28例，其中1例单层腓骨宽达2.16 cm；折叠腓骨瓣修复6例；单层腓骨瓣+游离植骨1例，共8例患者下颌骨高度得到完美恢复。皮岛方面，因穿支缺如无皮岛者1例，30例携带1个皮岛，4例携带双皮岛，软组织缺损修复效果良好。结论：血管化FFF应用灵活，除能恢复下颌骨连续性外，还可以通过多种手段恢复下颌骨高度，并携带双皮岛修复复杂的软组织缺损。

关键词: 血管化腓骨瓣, 下颌骨缺损, 修复重建, 皮岛

Abstract:

Objective: To evaluate the diversity and flexibility of vascularized free fibular flap (FFF) for soft and hard tissue defects of the lower third of face and oromandibular reconstruction. Methods: We collected 35 patients who underwent segmental resection of the mandible due to benign or malignant tumors and reconstructed with vascularized FFF. The types of mandibular defects, preoperative design, methods of FFF reconstruction and categories of skin islands were analyzed. Results: According to the COM classification, there were 6 cases of type Ⅰ, 26 cases of type Ⅱ and 3 cases of type Ⅲ. The length of the mandibular defects ranged from 4.85 cm to 17.00 cm, with an average of (8.29±2.69) cm. Among them, 28 cases were reconstructed with vascularized FFF, in which the width of the monolayer fibula was 2.16 cm in one case; 6 cases were rebuilt with folded vascularized FFF; 1 case was restored with monolayer vascularized FFF plus non-vascularized free fibula. Therefore, totally 8 cases perfectly restored the height of the mandible. In terms of skin islands, 1 case had no skin island due to the absence of peroneal perforator, 30 cases carried 1 skin island, 4 cases carried double skin islands, the soft tissue defects were well restored. Conclusion: The vascularized FFF has the advantage of flexibility. In addition to restoring the continuity of the mandible, it can rebuild the height of the mandible through a variety of ways. Besides, it can also carry double skin islands to repair complex soft tissue defects.

Key words: vascularized free fibula flap, mandibular defect, reconstruction, skin island

中图分类号:

R782.05

宋丽娜, 吴春月, 秦清岩, 楚天舒, 刘麒麟. 不同类型血管化游离腓骨瓣修复下颌骨缺损的回顾性分析[J]. 《口腔颌面外科杂志》, 2023, 33(2): 104-110.

SONG Lina, WU Chunyue, QIN Qingyan, CHU Tianshu, LIU Qilin. Different types of vascularized free fibula flaps for the reconstruction of mandibular defects：A retrospective analysis[J]. 《Journal of Oral and Maxillofacial Surgery》, 2023, 33(2): 104-110.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2023/V33/I2/104

图/表 7

表1 不同类型的血管化FFF修复下颌骨缺损的临床效果

Table 1 Clinical effects of different types of vascularized FFF for repairing mandibular defects

腓骨瓣类型	临床效果	处理方法	例（%）
血管化FFF（单层）	单纯恢复下颌骨连续性	常规下缘摆放	26 (74.2)
	恢复下颌骨连续性+牙槽突高度	高位移植摆放	1 (2.9)
	恢复下颌骨连续性+下颌骨高度	常规下缘摆放	1 (2.9)
血管化游离折叠腓骨瓣（双层）	恢复下颌骨连续性+下颌骨高度	双层或一层半折叠	6 (17.1)
血管化FFF（单层）+下方游离植骨	恢复下颌骨连续性+下颌骨高度	腓骨上抬摆放+下方游离植骨	1 (2.9)

表2 腓骨宽度与下颌骨高度比对血管化FFF修复的临床意义

Table 2 The clinical significance of the ratio of fibular width to mandibular height in repair of mandibular defects using vascularized FFF

腓骨宽度∶下颌骨高度	临床意义	例（%）
≤1/2	需要行双层腓骨折叠	24 (68.6)
>1/2	需要行一层半腓骨折叠	10 (28.6)
接近3/4	需要单层腓骨	1 (2.8)

表3 穿支血管的类型与软组织缺损修复效果的关系

Table 3 The relationship between the types of perforators and the repair of soft tissue defects

携带皮岛的类型	穿支来源	临床疗效	例（%）
单一皮岛	远端穿支	同时完成软硬组织缺损修复	29 (82.8)
单一皮岛	近端穿支	同时完成软硬组织缺损修复	1 (2.9)
无皮岛	无穿支	无明显软组织缺损，创口一期愈合	1 (2.9)
双皮岛	1个近端穿支+ 1个远端穿支	成功修复复杂软组织缺损	1 (2.9)
双皮岛	2个远端穿支	成功修复口内外软组织缺损	3 (8.6)

图1 患者1术前及术后1个月的面部照 A—B.术前的正面及侧面照；C—D.术后1个月正面及侧面照。

Figure 1 Facial photographs of the case 1 before operation and 1 month postoperation

图2 血管化折叠FFF修复下颌骨缺损 A—C. 术前口内照、CT影像及全景片； D. 切除的病损下颌骨；E.术中制备腓骨瓣双层折叠；F. 用双层折叠的腓骨修复下颌骨缺损；G—I. 术后1个月口内照、颌骨3D重建及全景片。

Figure 2 Mandibular defect repaired by vascularized double-barrel FFF

图3 患者2术前及术后1个月面部照 A—B.术前正面、侧面照； C—D.术后1个月正面及侧面照。

Figure 3 Facial photographs of case 2 before operation and 1 month postoperation

图4 单层血管化FFF修复下颌骨缺损 A—C.术前口内照、全景片及以咬合为导向的计算机辅助设计腓骨重建；D.切除的下颌骨及病损；E.术中制备的腓骨瓣；F. 术中用腓骨瓣修复下颌骨缺损；G—I. 术后1个月口内照、全景片及颌骨3D重建。

Figure 4 Mandibular defect repaired by vascularized signal-layer FFF

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