血管化复合组织瓣修复全上颌骨缺损的临床进展

摘要/Abstract

摘要： 上颌骨、软腭、颊等组成的面中份结构不仅支撑面部外形、决定个人的面容,同时参与完成咀嚼、吞咽、语音和维持正常视觉等重要功能。因此,上颌骨重建是头颈部缺损修复中最复杂、最有争议的临床课题之一,其中以保留眶内容物的全上颌骨缺损（James Brown Ⅲb类）重建尤为困难。本文对保留眶内容物全上颌骨缺损的血管化复合组织瓣的修复重建目标、方法选择以及相关问题作一综述。

关键词: 全上颌骨缺损, 腓骨瓣, 髂骨瓣, 肩胛骨瓣

Abstract: The importance of the central portion of the face, including the maxilla, cheek, palate, cannot be underestimated. This portion of the face provides much of the facial appearance,as well as supports the function of mastication, deglutition,speech and normal vision. So reconstruction of a mid-facial defect is one of the most complex and controversial tasks in head and neck reconstructive surgery, among which reconstruction of total maxillary defects with preservation of orbital contents (James Brown Class Ⅲb) is the most difficult. In the present article, we reviewed the goals of total maxillary reconstruction, the methods to reconstruct the total maxillary defects with vascularized osseous composite flaps and issues related to bone reconstruction.

Key words: Total maxillary defects, Fibular composite flap, Iliac crest composite flap, Scapular composite flap

中图分类号:

R782.2.3

于淼, 秦兴军, 徐立群. 血管化复合组织瓣修复全上颌骨缺损的临床进展[J]. 中国口腔颌面外科杂志, 2015, 13(3): 273-279.

YU Miao, QIN Xing-jun, XU Li-qun. Progress on reconstruction of total maxillary defects with vascularized osseous composite flap[J]. China J Oral Maxillofac Surg, 2015, 13(3): 273-279.

参考文献

[1] Brown JS, Shaw RJ. Reconstruction of the maxilla and midface: introducing a new classification [J]. Lancet Oncol, 2010, 11(10): 1001-1008.
[2] O'Connell DA, Futran ND. Reconstruction of the midface and maxilla [J]. Curr Opin Otolaryngol Head Neck Surg, 2010, 18(4): 304-310.
[3] Futran ND, Haller JR. Considerations for free-flap reconstruction of the hard palate [J]. Arch Otolaryngol Head Neck Surg, 1999, 125(6): 665-669.
[4] Neligan PC. Head and neck reconstruction[J]. Plast Reconstr Surg, 2013, 131(2): 260e-269.
[5] Nagasao T, Nakajima T, Kimura A, et al. The dynamic role of buttress reconstruction after maxillectomy[J]. Plast Reconstr Surg, 2005, 115(5): 1328-1340.
[6] Futran ND, Mendez E. Developments in reconstruction of midface and maxilla [J]. Lancet Oncol, 2006, 7(3): 249-258.
[7] Kazaoka Y, Shinohara A, Yokou K, et al. Functional reconstruction after a total maxillectomy using a fibula osteocutaneous flap with osseointegrated implants [J]. Plast Reconstr Surg,1999,103(4):1244-1246.
[8] Urken ML, Cheney ML, Sullivan MJ, et al. 头颈部组织瓣重建手术图谱[M]. 张维天, 时海波, 易红良, 译. 西安: 世界图书出版公司, 2011: 266-267.
[9] Rodriguez ED, Martin M, Bluebond-Langner R, et al. Microsurgical reconstruction of posttraumatic high-energy maxillary defects: establishing the effectiveness of early reconstruction [J]. Plast Reconstr Surg, 2007, 120(7 Suppl 2): 103S-117S.
[10] Peng X, Mao C, Yu GY, et al. Maxillary reconstruction with the free fibula flap [J]. Plast Reconstr Surg, 2005, 115(6): 1562-1569.
[11] Yazar S, Cheng MH, Wei FC, et al. Osteomyocutaneous peroneal artery perforator flap for reconstruction of composite maxillary defects [J]. Head Neck, 2006, 28(4): 297-304.
[12] Frodel JL Jr, Funk GF, Capper DT, et al. Osseointegrated implants: a comparative study of bone thickness in four vascularized bone flaps [J]. Plast Reconstr Surg, 1993, 92(3): 449-455.
[13] Mücke T, Hölzle F, Loeffelbein DJ, et al. Maxillary reconstruction using microvascular free flaps [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2011, 111(1): 51-57.
[14] Rogers SN, Lakshmiah SR, Narayan B, et al. A comparison of the long-term morbidity following deep circumflex iliac and fibula free flaps for reconstruction following head and neck cancer [J].Plast Reconstr Surg, 2003, 112(6): 1517-1525.
[15] de la Parra M, Sanchez G, Lopez J, et al. Total maxillary reconstruction using a double-barreled and double skin paddle fibular flap after total maxillectomy [J]. Arch Plast Surg, 2013, 40(6): 779-782.
[16] Wang WH, Xu B. Maxillary reconstruction using vascularized fibular osteomyocutaneous flap and iliac bone through modified lateral lip-submandibular approach [J]. J Craniofac Surg, 2013, 24(4): 1453-1457.
[17] Sun J, Shen Y, Li J, et al. Reconstruction of high maxillectomy defects with the fibula osteomyocutaneous flap in combination with titanium mesh or a zygomatic implant [J]. Plast Reconstr Surg, 2011, 127(1): 150-160.
[18] Shipchandler TZ, Waters HH, Knott PD, et al. Orbitomaxillary reconstruction using the layered fibula osteocutaneous flap [J]. Arch Facial Plast Surg, 2012, 14(2): 110-115.
[19] Futran ND, Wadsworth JT, Villaret D, et al. Midface reconstruction with the fibula free flap [J]. Arch Otolaryngol Head Neck Surg, 2002, 128(2): 161-166.
[20] Chang DW, Langstein HN. Use of the free fibula flap for restoration of orbital support and midfacial projection following maxillectomy [J]. J Reconstr Microsurg, 2003, 19(3): 147-152.
[21] Anthony JP, Foster RD, Sharma AB, et al. Reconstruction of a complex midfacial defect with the folded fibular free flap and osseointegrated implants [J]. Ann Plast Surg, 1996, 37(2): 204-210.
[22] Brown JS. Deep circumflex iliac artery free flap with internal oblique muscle as a new method of immediate reconstruction of maxillectomy defect [J]. Head Neck, 1996, 18(5): 412-421.
[23] Brown JS, Jones DC, Summerwill A, et al. Vascularized iliac crest with internal oblique muscle for immediate reconstruction after maxillectomy [J]. Br J Oral Maxillofac Surg, 2002, 40(3): 183-190.
[24] Iyer S, Chatni S, Kuriakose MA. Free tensor fascia lata-iliac crest osteomusculocutaneous flap for reconstruction of combined maxillectomy and orbital floor defect [J]. Ann Plast Surg, 2012, 68(1): 52-57.
[25] Bianchi B, Ferri A, Ferrari S, et al. Iliac crest free flap for maxillary reconstruction [J]. J Oral Maxillofac Surg, 2010, 68(11): 2706-2713.
[26] Genden EM, Wallace D, Buchbinder D, et al. Iliac crest internal oblique osteomusculocutaneous free flap reconstruction of the postablative palatomaxillary defect [J]. Arch Otolaryngol Head Neck Surg, 2001, 127(7): 854-861.
[27] Shaw RJ, Brown JS. Osteomyocutaneous deep circumflex iliac artery perforator flap in the reconstruction of midface defect with facial skin loss: a case report [J]. Microsurgery, 2009, 29(4): 299-302.
[28] Maranzano M, Atzei A. The versatility of vascularized iliac crest with internal oblique muscle flap for composite upper maxillary reconstruction [J]. Microsurgery, 2007, 27(1): 37-42.
[29] Lyons AJ, James R, Collyer J. Free vascularised iliac crest graft: an audit of 26 consecutive cases [J]. Br J Oral Maxillofac Surg, 2005, 43(3): 210-214.
[30] Valentini V, Gennaro P, AbohIV, et al. Iliac crest flap: donor site morbidity [J]. J Craniofac Surg, 2009, 20(4): 1052-1055.
[31] Swartz WM, Banis JC, Newton ED, et al. The osteocutaneous scapular flap for mandibular and maxillary reconstruction [J]. Plast Reconstr Surg, 1986, 77(4): 530-545.
[32] Coleman JJ 3rd, Sultan MR. The bipedicled osteocutaneous scapula flap: a new subscapular system free flap [J]. Plast Reconstr Surg, 1991, 87(4): 682-692.
[33] Yoshioka I, Yamashita Y, Khanal A, et al. Maxillary reconstruction using a bipedicled osteocutaneous scapula flap [J]. Int J Oral Maxillofac Surg, 2009, 38(12): 1311-1315.
[34] Clark JR, Vesely M, Gilbert R. Scapular angle osteomyogenous flap in postmaxillectomy reconstruction: defect, reconstruction, shoulder function, and harvest technique [J]. Head Neck, 2008, 30(1): 10-20.
[35] Kakibuchi M, Fujikawa M, Hosokawa K, et al. Functional reconstruction of maxilla with free latissimus dorsi-scapular osteomusculocutaneous flap [J]. Plast Reconstr Surg, 2002, 109(4): 1238-1244.
[36] Miles BA, Gilbert RW. Maxillary reconstruction with the scapular angle osteomyogenous free flap [J]. Arch Otolaryngol Head Neck Surg, 2011, 137(11): 1130-1135.
[37] Wagner AJ, Bayles SW. The angular branch: maximizing the scapular pedicle in head and neck reconstruction [J]. Arch Otolaryngol Head Neck Surg, 2008, 134(11): 1214-1217.
[38] Hasan Z, Gore SM, Ch'ng S, et al. Options for configuring the scapular free flap in maxillary, mandibular, and calvarial reconstruction [J]. Plast Reconstr Surg, 2013, 132(3): 645-655.
[39] Piazza C, Paderno A, Taglietti V, et al. Evolution of complex palatomaxillary reconstructions: the scapular angle osteomuscular free flap [J]. Curr Opin Otolaryngol Head Neck Surg, 2013, 21(2): 95-103.
[40] Brown J, Bekiroglu F, Shaw R. Indications for the scapular flap in reconstructions of the head and neck [J]. Br J Oral Maxillofac Surg, 2010, 48(5): 331-337.
[41] Urken ML, Bridger AG, ZurK B, et al. The scapular osteofasciocutaneous flap: a 12-year experience [J]. Arch Otolaryngol Head Neck Surg, 2001, 127(7): 862-869.
[42] Yamamoto Y, Sugihara T, Kawashima K, et al. An anatomic study of the latissimus dorsi-rib flap: an extension of the subscapular combined flap [J]. Plast Reconstr Surg, 1996, 98(5): 811-816.
[43] Suga H, Asato H, Okazaki M, et al. Combination of costal cartilage graft and rib-latissimus dorsi flap: a new strategy for secondary reconstruction of the maxilla [J]. J Craniofac Surg, 2007, 18(3): 639-642.
[44] Yamamoto Y, Sugihara T, Kuwahara H, et al. An anatomic study for the rectus abdominismyocutaneous flap combined with a vascularized rib [J]. Plast Reconstr Surg, 1995, 96(6): 1336-1340.
[45] Davison SP, Boehmler JH, Ganz JC, et al. Vascularized rib for facial reconstruction [J]. Plast Reconstr Surg, 2004, 114(1): 15-20.
[46] O'Connell DA, Futran ND. Reconstruction of the midface and maxilla [J]. Curr Opin Otolaryngol Head Neck Surg, 2010, 18(4): 304-310.
[47] Avery CM. Review of the radial free flap: still evolving or facing extinction? Part two: osteocutaneous radial free flap [J]. Br J Oral Maxillofac Surg, 2010, 48(4): 253-260.
[48] Sun J, Shen Y, Weng YQ, et al. Lateral lip-splitting approach for total and subtotal Maxillectomy [J]. J Oral Maxillofac Surg, 2009, 67(6): 1197-1205.
[49] Jedrzejewski P, Maciejewski A, SzymczykC, et al. Maxillary reconstruction using a multi-element free fibula flap based on a three-dimensional polyacrylic resin model [J]. Pol Przegl Chir, 2012, 84(1): 49-55.
[50] Liu XJ, Gui L, Mao C, et al. Applying computer techniques in maxillofacial reconstruction using a fibula flap: a messenger and an evaluation method [J]. J Craniofac Surg, 2009, 20(2): 372-377.