以游離血管莖骨皮瓣重建下頷骨廣泛缺損之經驗

台中榮民總醫院從1994年9月至1996年8月共有14例下頜骨廣泛缺損(composite defect)，立即以游離腓骨骨皮瓣(free fibula osteocutaneous flap: FFOF)，或游離橈動脈前臂骨皮瓣(free radial forearm osteocutaneous flap: FPFOF)來重建。FFOF有10例，FRFOF有4例，除一例FFOF失敗外，手術成功率爲93%，併發症有7例。在本報告中，我們認爲其主要特點爲：1．利用這兩種游離骨皮瓣重建下頜骨廣泛缺損，皆可得到良好的結果，且可儘早安排術後放射治療。2．兩種骨瓣皆可使用截骨術(osteotomy)，並且以重建金屬板(reconstruction plate)、微小金屬板(miniplate)、螺絲釘(screw)或鋼絲(wire)來固定骨頭，不但可重新塑造出所需要的下頜骨，而且對於骨頭癒合影響不大。3．以FFOF重建下頜骨廣泛缺損，對於下頜骨缺損在長度上幾乎沒有限制，而且可利用之皮膚島(skinisland)範圍相當大，可靠性佳。4．以FRFOF重建下頜骨廣泛缺損，雖然骨瓣可利用的長度及厚度不如FFOF，然而其皮膚島所具有的許多優點，使它在某些適應症下仍是很好的選擇。5．即使術後受瓣處的併發症不少，但在處理上並不困難。6．兩種骨皮瓣供瓣處的罹病性(morbidity)問題不大。總而言之，在不同的適應症下，這兩種游離骨皮瓣對於重建下頜骨廣泛缺損上，都是理想的選擇，外觀及功能恢復皆有不錯的結果。

關鍵字

遊離橈動脈前臂骨皮瓣；游離腓骨骨皮瓣；截骨術

並列摘要

At Taichung Veteran General Hospital, we apply free fibula and radical forearm osteocutaneous flap to reconstruct composite mandibular defects. From Sep., 1994 to Aug., 1996, 14 consecutive patients ranging in age from 31 to 69 years received immediate reconstruction of composite mandibular defects with 10 free fibula osteocutaneous flaps (FFOF) and 4 free radial forearm osteocutaneous flaps (FRFOF). Only one case of FFOF failed and seven of these had surgical complications. The results not only demonstrate the advantages of using these two composite free flaps but also indicate that this technique can help the patients undergo post-operative radiotherapy as soon as possible. On the other hand, the osteotomies are performed in these two flaps and they are fixed with reconstruction plates, miniplates, screws, and wires to produce a new mandible. However, the osteotomies have little influence on the bone union. Moreover, FFOF has almost no limitations for mandibular reconstruction in the length of the bone defects, and the available skin island can be rather large and reliable. Although FRFOF has limitations in the length of the bone defects, it is still a good choice in some indications because of the advantages of the skin island available in this flap. Even though there are some surgical complications in the recipient sites, they are not difficult to manage. As for the morbidity, the donor site morbidity of these two flaps are low. In conclusion, both FFOF and FRFOF are ideal donor sites for composite mandibular reconstruction in the various indications, and the function and aesthetic result of the mandibular reconstruction are excellent.

並列關鍵字

free radial forearm osteocutaneous flap: FPFOF ； free fibula osteocutaneous flap: FFOF ； osteotomy

國際替代計量

以游離血管莖骨皮瓣重建下頷骨廣泛缺損之經驗

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