Comparison of the Flap Viability Among Primary and Secondary Mandibular Reconstruction with Vascularized Fibular Flap

用腓骨自由皮瓣作下顎骨立即性與延遲性重建的皮瓣存活率比較

楊沂勳(Yi-Hsun Yang) ； 施翔順(Hsiang-Shun Shih) ； 馮冠明(Guan-Ming Feng) ； 陳建安(Jian-An Chen) ； 鄭勝峰(Seng-Feng Jeng)

《臺灣整形外科醫學會雜誌》 25卷4期 (2016/12) Pp. 314-329

摘要

Background: Despite the difficulty of mandibular reconstruction, few articles have attempted to analyze the differences between the primary and secondary operative procedures, particularly the selection of recipient vessel. The aim of this study is to compare the reconstructive procedures of patients who underwent primary and secondary mandibular reconstruction in southern Taiwan. Material and Methods: We defined the primary mandibular reconstruction as those patients who received immediate reconstruction with free fibular flap after the tumor ablation surgery. The secondary mandibular reconstruction was defined as reconstruction after the first stage of tumor ablation surgery. The segmental mandible defect was not immediately reconstructed and the mandibular reconstruction was done at secondary stage. We retrospectively collected patients undergoing primary (n = 31) and secondary (n = 18) mandibular reconstruction from 2001~2014. The differences between the two groups were evaluated using Student's t-test, Fisher's exact test and chi-square test. Results: The two groups shared similar demographic profile and medical comorbidities. There is a significant difference in the recipient vessel selection between the two groups. The contra-lateral facial artery (p = 0.007) and the superficial temporal artery (p ＜0.001) were both significantly used more in the secondary reconstruction, whereas the superior thyroid artery was significantly used more in the primary reconstruction (p ＜0.001). There was no significant difference in the overall proportion of patients who experienced one or more complications between the two groups. Conclusion: Our study shows significant differences in vessels selection between primary and secondary reconstruction groups. Even though the secondary mandibularreconstruction poses a greater challenge, the complication, re-operation, and flap survival rate were not significantly different from those of the primary reconstruction group.

關鍵字

secondary mandibular reconstruction ； sequential ； irradiation ； fibular flap

並列摘要

背 景：儘管下顎骨的重建困難，現今在這立即性及延遲性下顎骨重建的文獻相當缺少，特別是移植接受區血管選擇的討論更是闕如。這篇文章主要試著比較在南台灣的經驗裡，作立即性與延遲性下顎骨重建的病人中，是否有相關數據的差異。材料及方法：我們定義立即性重建便是在行腫瘤切除手術後，隨即的也完成了腓骨游離皮瓣重建的族群。而延遲性重建組，就是在第一時間作完腫瘤切除手術後，並沒有立即的完成下顎骨重建，而是在往後的第二階段裡才進行腓骨游離皮瓣下顎骨重建手術。我們回朔式的從西元2001 到2014 年間，收集了作立即性下顎骨重建的病人31 位，延遲性重建的病人共18 位。而組別之間相關數據差異的分析，我們採用了Student’s t-test, Fisher’s exact test and chi-square test.。結 果：在這兩個族群裡，他們的人口特徵及醫療相關問題的統計分析，是相似的。但在移植接受區血管的選擇，這兩個族群確實有統計學上的差異存在。如在延遲性下顎骨重建族群裡，對側的顏面動脈 (p =0.007) 及同側的淺顳動脈 (p ＜0.001) 確實使用率較高；在立即性下顎骨重建的族群裡，上甲狀腺動脈的使用也確實比較高 (p ＜0.001)。但在兩個族群裡，論及併發症方面來說，並沒有顯著的差異存在。（除了延遲性手術的皮瓣的感染率較高以外）結 論：我們的文章裡發現了立即性與延遲性下顎骨重建在移植接受區血管的差異性確實存在。即便是延遲性下顎骨重建是一個很大的挑戰，但事實上在皮瓣的存活率、救援手術、併發症的比率來說，並沒有明顯的差異存在。