Immediate Free Flap Reconstruction in the Management of Advanced Mandibular Osteoradionecrosis

立即自由皮辦重建於治療嚴重下頷骨放射性骨壞死之應用

鄭乃禎(Nai-Chen Cheng) ； 陳明庭(Ming-Ting Chen) ； 戴浩志(Hao-Chi Tai) ； 湯月碧(Yueh-Bih Tang)

《中華民國整形外科醫學會雜誌》 14卷2期 (2005/06) Pp. 121-130

https://doi.org/10.7096/JPSA.200506.0121

摘要

治療嚴重下頷骨放射性骨壞死是一項困難的臨床挑戰，當這些病人對保守性治療沒有反應，或發生病理性骨折時，即有必要廣泛切除所有被侵犯的下頷骨及其周圍的軟組織。我們回溯分析過去十年在本院因下頷骨放射性骨壞死接受廣泛切除及立即自由皮辦重建的13位病患。全部的病患皆為男性，曾因頭頸部腫瘤接受過放射治療，平均年齡為53.8歲。我們共使用8塊腓骨皮辦及5塊腸骨脊皮辦。除了1塊腓骨皮辦，所有的皮辦均成功存活，壞死的腓骨皮辦以胸大肌皮辦進行拯救手術。平均術後追蹤時間為4年9個月（3個月至10年），所有病患放射性骨壞死的症狀皆完全緩解。除一位病人於術後五年在對側下頷骨產生放射性骨壞死，所有病患皆無放射性骨壞死復發的情形，且有功能上及美觀上的良好預後。我們的經驗顯示，廣泛切除及立即自由皮辦重建對嚴重下頷骨放射性骨壞死的病患是十分有效的治療方法。

並列摘要

Management of advanced mandibular osteoradionecrosis (ORN) is a difficult and challenging clinical problem. When the patient fails to respond to the conservative treatment, or has pathological fracture, radical resection of the involved mandible and surrounding soft tissue is necessary. We retrospectively reviewed 13 patients who received immediate free flap reconstruction after radical resection for mandibular ORN within the past ten years. All patients were male who received radiotherapy for head and neck cancer. The mean age was 53.8 years. Among the reviewed cases, eight fibula flaps and five iliac crest flaps were employed. All flaps survived except one fibula flap, which was salvaged with a pectoralis major myocutaneous flap. The mean follow-up time was 4 years and 9 months (range, 3 months to 10 years). Every patient experienced complete resolution of ORN symptoms. No evidence of ORN recurrence was observed, except one developed new ORN at the contralateral mandible five years after the operation. Satisfactory functional and aesthetic outcomes could be achieved in all patients. Our experience showed that radical resection and immediate reconstruction with free composite bone flap offers an effective treatment in patients with extensive mandibular ORN.

並列關鍵字

mandibular osteoradionecrosis ； fibula flap ； iliac crest flap