游离腓骨肌筋膜瓣修复肿瘤切除后颌骨和口腔黏膜缺损

中国口腔颌面外科杂志 ›› 2015, Vol. 13 ›› Issue (6): 545-549.

游离腓骨肌筋膜瓣修复肿瘤切除后颌骨和口腔黏膜缺损

范松，王友元，张汉卿，林钊宇，钟江龙，陈伟雄，李群星，郁鑫，李劲松

中山大学孙逸仙纪念医院口腔颌面外科，广东广州 510120

收稿日期:2014-11-22 出版日期:2015-11-20 发布日期:2015-12-03
通讯作者: 李劲松，Tel：020-81332220，E-mail：lijinsong1967@163.com
作者简介:范松（1982-），男，主治医师， E-mail：fansong8888@163.com

Reconstruction of jaw and oral mucosal defects with fibular osteomyofascial flap after oncological ablation

FAN Song, WANG You-yuan, ZHANG Han-qing, LIN Zhao-yu, ZHONG Jiang-long, CHEN Wei-xiong, LI Qun-xing, YU Xing, LI Jin-song.

Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University. Guangzhou 510120, Guangdong Province, China

Received:2014-11-22 Online:2015-11-20 Published:2015-12-03

摘要/Abstract

摘要： 目的：腓骨肌皮瓣广泛用于口腔颌面部软、硬组织缺损修复，然而，其皮岛在口腔内常显得臃肿，特别是在牙槽区，不利于义齿修复。为寻找一种更适合的口腔衬里，本研究采用腓骨肌筋膜瓣代替传统的腓骨肌皮瓣，以避免后期牙列修复所面临的诸多问题。方法：2012年5月—2014年5月间，38例上、下颌骨肿瘤切除术后患者行腓骨肌筋膜瓣修复，33例患者行常规腓骨肌皮瓣修复。对患者年龄、颌骨缺损类型、筋膜（皮）瓣大小、去除臃肿皮瓣手术次数、供区和受区并发症以及牙列修复情况进行统计分析。结果：所有筋膜瓣全部存活并黏膜化。筋膜瓣组牙列修复患者无需行额外手术去除臃肿组织，84% (32/38)患者行活动义齿修复，其美观和咀嚼功能满意。而肌皮瓣组仅52%(17/33)患者行活动义齿修复，其中10例义齿修复前需行手术去除臃肿软组织。结论：腓骨肌筋膜瓣可提供一种理想的口腔衬里，避免了牙列修复前去除臃肿皮岛的手术；同时无毛发生长，患者口腔更舒适且有利于口腔自洁，并避免小腿植皮手术，减少供区并发症。

关键词: 腓骨肌筋膜瓣, 腓骨肌皮瓣, 颌骨肿瘤切除

Abstract: PURPOSE : The use of fibular osteomyocutaneous flaps is a widely accepted technique for soft and hard tissue reconstruction in oromaxillofacial region. However, soft tissue bulk, which covers alveolar regions by the skin paddle, is not qualified for dental rehabilitation. To achieve an ideal intraoral lining, we harvested the fibular osteomyofascial flap to avoid the commonly seen embarrassment caused by fibular osteomyocutaneous flap. METHODS : Between May 2012 and May 2014, 38 patients underwent reconstruction of the maxilla and mandible using an osteomyofascial free fibula flap following oncological ablation, while 33 patients underwent reconstruction using a traditional fibular osteomyocutaneous flap. Data including the patient’s age, cause and type of defects, size of the fascial(skin) flaps, number of debulking operations, complications at both the donor and recipient sites, and the dental rehabilitation were collected and analyzed. RESULTS : All fascial flaps survived and were remucosalized. None of the patients in the osteomyofascial group required an additional debulking operation, and 84% (32/38) of the patients had conventional dentures and showed good chewing function and cosmetic results. However, only 52%(17/33) of patients in the osteomyocutaneous group underwent definitive prosthesis placement while 10 patients required debulking before dental rehabilitation. CONCLUSIONS : The fibular osteomyofascial flap, without hair-bearing but comfortable and good oral hygiene, yielded a more anatomic solution for oral mucosal defects, obviating the need for additional debulking and potentially reducing donor-site wound problems.

Key words: Fibular osteomyofascial flap, Fibular osteomyocutaneous flap, Jaw tumour ablation

中图分类号:

R782.2

范松，王友元，张汉卿，林钊宇，钟江龙，陈伟雄，李群星，郁鑫，李劲松. 游离腓骨肌筋膜瓣修复肿瘤切除后颌骨和口腔黏膜缺损[J]. 中国口腔颌面外科杂志, 2015, 13(6): 545-549.

FAN Song, WANG You-yuan, ZHANG Han-qing, LIN Zhao-yu, ZHONG Jiang-long, CHEN Wei-xiong, LI Qun-xing, YU Xing, LI Jin-song.. Reconstruction of jaw and oral mucosal defects with fibular osteomyofascial flap after oncological ablation[J]. China J Oral Maxillofac Surg, 2015, 13(6): 545-549.

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