- 期刊
腓骨游離皮瓣於顎骨重建之十年回溯性研究
A Retrospective Study of Fibula Free Flap in Jaw Bone Over a Ten-year Period
摘要
目的：腓骨游離皮瓣於顎骨重建的優勢在於其能塑型以符合外觀，並提供支撐強度，然而其骨頭與皮膚空間的關係使皮瓣自由度受到限制，也可能導致造成皮瓣的失敗。另外，對於捐贈區的大範圍剝離造成的傷口癒合不良在臨床上及研究上也時有所聞。本文的目的是回溯本院接受腓骨游離皮瓣重建病例之適應症與使用方式，分析其血管電腦斷層並探討與捐贈區發病率的關係。研究方法與材料：本研究使用本院病歷系統，以顯微皮瓣－骨移植之手術代碼與護理紀錄回溯本院自2007年至2018年利用腓骨游離皮瓣於下顎骨重建案例，紀錄包含患者癌症分期、性別、年齡、皮瓣結果與下肢血管電腦斷層。下肢血管的分類根據Kim的分類方式，並藉由卡方相關性分析來探討第三類血管分類與捐贈區發病率的相關性。結果：本院自2007－2018年間臨床案例統計使用腓骨游離皮瓣的成功率為98.5％（130／132）。下肢捐贈區的併發症率為22.1％。併發症的處理方式，有20例於清創後進行直接關閉縫合，8例使用分層植皮修補，2例使用顯微游離皮瓣進行重建。下肢血管不正常分類（Class III）的比例為3.2％，在卡方檢定的分析下，第三類血管分類與下肢捐贈區發病率並無顯著相關。結論：腓骨游離皮瓣非常適合用於顎骨區的重建，然而我們發現在捐贈區因為大範圍的組織剝離與失去腓動脈的供應，產生不少傷口癒合不良的案例，術者應對此有更進一步的認知與掌握不同的因應之道。
並列摘要
Purpose: The main benefit of fibula free flap is that it can be contoured to fit many kinds of jaw defects. However, the skin to bone relationship offers limited freedom, which may result in flap failure. In addition, the extensive dissection producing donor site morbidity is often reported and encountered. The purpose of this study is to review our cases using fibula flap, most especially: donor site vessels anatomy based on CT angiogram, where and when to use, surgical application and donor site morbidity. Material and methods: The data was collected from medical record of those who underwent microvascular free flap - bone flap of maxillofacial defect from Jan. 2007 to Jan. 2018. The data to be collected include the stage of cancer, gender, age, flap outcome and CT-angiography of lower extremities. The variation of peroneal artery was classified according to Kim's classification. The correlation analysis between class III vessel variation and flap success rate was performed with Pearson Chi-Square test. Results: From Jan. 2007 to Jan. 2018, 130 fibula flaps were utilized. The overall success rate was 98.5% (2 flap failures). The donor site morbidity rate is 22.1%. There were three categories for management of donor site wound morbidity. Firstly, debridement and primary closure (20 cases). Secondly, debridement requiring skin graft (8 cases). Thirdly, debridement with free flap repair (2 cases). The rate of abnormal variation of lower extremities (class III) is 3.2%. The Chi square test doesn't reveal the significant correlation between donor site morbidity with class III variation. Conclusion: The fibula flap is very suitable for mandible and maxilla reconstruction. We found the donor site wound breakdown is quite common due to the sacrifice of peroneal vessel causing adjacent structures lack of blood supply. So maxillofacial surgeons need to be prepared to face and manage the donor site problems.
延伸閱讀
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