游离腓骨肌皮瓣及CT血管造影技术在颌面部软硬组织缺损功能性重建中的应用

发布时间：2018-08-09 21:05

【摘要】：目的:评估应用游离腓骨肌皮瓣功能性重建口腔颌面部软硬组织缺损及术前增强CT血管造影检查的临床价值。方法:口腔癌患者8例,应用游离腓骨肌皮瓣一期修复下颌骨及周围软组织缺损,血管吻合采用端端吻合法,分析腓骨肌皮瓣的设计、大小、修复部位和存活情况等。术前行供瓣区增强CT断层扫描血管造影(CTA)排查腓骨肌皮瓣血管变异。结果:1例牙龈癌患者存在腓动脉与胫后动脉共干,改用其他肌皮瓣修复;余7例游离腓骨肌皮瓣全部成活,均携带1块皮岛,皮岛6cm×2cm~10.0cm×3.5cm,用于口内软组织缺损修复。术后语音功能基本正常,面部外形、功能及咬合关系良好。下肢功能在术后2周~2个月恢复正常。结论:术前CTA检查对游离腓骨肌皮瓣的供区评价具有十分重要的应用价值。游离腓骨肌皮瓣的骨量充足,具有骨膜和骨髓双重血供,抗感染能力强。可根据需要做截骨塑形从而更加准确地恢复颌骨牙槽突形态,腓骨的高度和宽度以及皮质骨的厚度也十分适合牙种植体的植入。游离腓骨瓣的皮岛还可作为术后血供的观察窗,是能够同时兼顾颌骨缺损及周围软组织缺损功能修复重建的理想方法。
[Abstract]:Objective: to evaluate the clinical value of functional reconstruction of soft and hard tissue defects in oral and maxillofacial region by free fibula myocutaneous flap and enhanced CT angiography before operation. Methods: the free fibula myocutaneous flap was used to repair mandibular and surrounding soft tissue defects in 8 patients with oral cancer. The design, size, site and survival of fibula myocutaneous flap were analyzed by end-to-end anastomosis. The vascularity of fibula myocutaneous flap was detected by CT enhanced computed tomography angiography (CTA) before operation. Results one patient with gingival cancer had common trunk of peroneal artery and posterior tibial artery and was repaired by other musculocutaneous flaps. All the other 7 free fibula myocutaneous flaps survived, carrying one skin island, 6cm 脳 2cm~10.0cm 脳 3.5 cm, for repairing the soft tissue defect in the mouth. Postoperative speech function is normal, facial shape, function and occlusal relationship are good. The lower limb function returned to normal 2 weeks to 2 months after operation. Conclusion: preoperative CTA examination is of great value in evaluating the donor area of free fibula myocutaneous flap. Free fibula myocutaneous flap has sufficient bone mass, double blood supply of periosteum and bone marrow, and strong anti-infection ability. The shape of alveolar process can be restored more accurately by osteotomy according to the need. The height and width of fibula and the thickness of cortical bone are also suitable for dental implant implantation. The free fibula flap can also be used as the observation window of blood supply after operation. It is an ideal method to repair and reconstruct the function of jaw bone defect and surrounding soft tissue defect at the same time.
【作者单位】：佛山市第二人民医院口腔颌面外科;
【基金】：佛山市科技局产学研项目(No:2011BC100011) 佛山市头颈疾病诊疗科研创新平台项目(No:2013AG10012)
【分类号】：R782.4

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