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目的探讨游离皮瓣在全下唇及颏部大范围缺损修复重建中的应用价值及临床效果。方法 2007年7月至2013年3月,对中国医科大学口腔医学院口腔颌面外科收治的12例下唇癌根治术后及2例外伤造成的全下唇及颏部缺损患者,应用前臂皮瓣和股前外侧皮瓣同期修复。术后随访6个月至3年,并对患者修复后下唇外观和功能进行评价。结果 14例皮瓣全部成活,成活率100%。术后随访下唇癌患者肿瘤未见复发,14例患者均可进行基本正常的语言交流;12例可进普食,2例进软食;1例流涎,均无小口畸形。下唇及颏部外观患者均能接受。结论应用游离皮瓣修复全下唇及颏部缺损,方法安全可靠且成功率较高,根据下唇及颏部缺损范围选择合适修复方式可获得较好的口腔功能和外观。     

A 31-year review of composite radial forearm free flaps for head and neck reconstruction

The aim of this study was to report the patient characteristics and radial fracture rates in a consecutive series of composite radial forearm free flap (CRFFF) for head and neck reconstruction over a 31-year period. The patients were identified from between 1990 to 2020 inclusive from theatre records and records from previous analyses at the Unit on free flap outcomes. Electronic case notes were accessed where available, to gather information on the operation, histopathology, and radiographs. Patients were categorised into three groups for analysis: (1) new oral cancers with a composite radial being the first choice of flap, (2) new oral cancers with a composite radial being the choice of flap following compromise of another bony flap, (3) osteoradionecrosis (ORN) cases. There were 103 CRFFF cases, median (IQR) age 69 (59-80) years, comprising 78 (Group 1), 5 (Group 2) and 20 (Group 3). The CRFFF failure rate was 6% (6/103) and the radius fracture rate was also 6% (6/103), both with 95% confidence interval 2.2-12.2%. Of the 6 radius fractures, 1 underwent surgical management (rush nailing), 1 died in hospital and the others managed with cast immobilisation. Two-year overall survival after surgery for the103 patients was 54% (SE 5%), while 5-year survival was 40% (SE 5%). In conclusion, in spite of the familiarity with other bone flaps such as fibular free flap, DCIA, scapula, and the limited bone stock and potential fracture related morbidity associated with the CRFFF, this flap still has a place in the surgical reconstructive armamentarium.     

口腔骨组织工程研究进展

创伤、炎症、肿瘤、先天畸形所引起口腔颌面部骨缺损的修复一直是口腔医学的难题,而组织工程已成为骨缺损修复新的研究热点。下面就骨组织工程及其在口腔医学领域的研究进展作一综述。     

Second metatarsal free transfer in total temporomandibular joint reconstruction for ankylosis in a child: 10-year follow-up

The management of temporomandibular joint (TMJ) ankylosis requires complete removal of the ankylosed block and the prevention of recurrence. For this purpose, the ramus–condyle unit can be reconstructed with a second metatarsal free flap. This article reports the use of this flap in a young patient treated for left TMJ ankylosis, post costochondral graft for the treatment of hemifacial microsomia. Data from the 10-year follow-up are reported. The glenoid fossa was reconstructed with a graft of the second metatarsal base, enabling the juxtaposition of two cartilaginous joint surfaces, with the aim of optimizing the functional result and preventing the recurrence of ankylosis. At the 10-year follow-up after this surgery, there was no recurrence of the ankylosis and no articular disorder, and the morphological result was satisfactory. Bone fixation was stable over the 10-year period and the metatarsal head was still in place. Quantitative measurements obtained by computed tomography scan did not show any growth of the second metatarsal free flap compared to the right unaffected condylar process.     

“Chain-link” combined tissue transfer for the reconstruction of the mandible

We describe a procedure for “chain-link” combined tissue transfer connecting the vascular pedicle of a deep circumflex iliac flap with that of a forearm flap after wide resection of the mandible. Combination of these flaps facilitated the reconstruction of the defect in both intra- and extraoral soft tissue and the mandibular bone. This method is useful when cervical recipient blood vessels are limited due to the wide resection of the primary tumor and radical neck dissection.     

Development of a novel resection and cutting guide for mandibular reconstruction using free fibula flap

Introduction

The authors developed a semi-standardised resection and cutting guide for mandibular reconstruction with free fibula flap based on data of mandible sizes and angles.

Reverse blood flow as an option in mandibular reconstruction using a two-segment fibula free flap

Microsurgical reconstruction is currently considered a method of choice for the repair of soft tissue or bony defects in head and neck surgery. This technical note presents the use of a reverse flow technique in mandibular reconstruction with two segments of fibula free flap in a patient with bilateral pseudoarthrosis. In the standard procedure, both segments of the fibula are supplied by one donor vascular pedicle with normal antegrade blood flow. The approach presented here employs reverse flow in the distal segment of the fibula using a venous graft to create two vascular independent free fibula segments. Reverse flow in mandibular reconstruction represents an alternative option to support the success of microsurgical procedures in indicated cases.     

Mandibular reconstruction with free fibula flaps in the elderly: a retrospective evaluation

The purpose of this study was to evaluate surgical outcomes in elderly patients who had undergone free fibula flap transfer for malignant head and neck tumours. A retrospective chart review was performed to identify patients who had undergone free fibula flap transfer for mandibular reconstruction after malignant tumour resection at Jichi Medical University Hospital between May 2009 and April 2015. Enrolled patients were divided into an elderly group (≥80 years old) and a younger group (<80 years old). Seventeen patients met the inclusion criteria and were included in the elderly group. Age at surgery ranged from 80 to 92 years. Thirteen patients (76.5%) experienced postoperative complications. Surgical site complications occurred in seven patients. The success rate of free fibula flap transfer was 100%. Systemic complications occurred in nine patients, most commonly delirium (n = 6). No perioperative mortality was encountered. The overall 1-year survival rate was 94.1% (16/17). No patient reported gait disturbance as a donor site complication or any other major complication. The incidence of postoperative complications did not differ significantly between the elderly and younger groups. Almost no difference in postoperative course was seen between the groups. Elderly patients appear to tolerate free fibula flap reconstruction just as well as younger patients.     

Review and update on the use of the microanastomotic coupler device for arterial anastomosis in free tissue transfer

While a simple interrupted sutured anastomosis remains the gold standard in microsurgery, the introduction of the microanastomotic coupler device (MACD) has decreased procedure time and thrombosis risk, and improved the patency of venous anastomoses. The aim of this review is to update the evidence-based advantages of the MACD on arteries, based on clinical and experimental data, and to compare them to the hand-sewn approach in free flap transfer. All relevant articles that appeared in the PubMed and Medline/Ovid databases during the past three decades were reviewed. After exclusions, 11 studies were retained and discussed.The MACD had a generally shorter arterial anastomosis time, with improved flap survival and reduced ischaemia compared with the hand-sewn approach. The use of the MACD in arterial anastomosis is an efficient and less time-consuming alternative to the hand-sewn technique, provided that the selection of vessels is appropriate and the vessel diameter is large enough to do the anastomosis.     

Role of real-time colour-flow Doppler in perforator free flap head and neck reconstruction

We discuss the use of real-time colour-flow Doppler ultrasound to optimally evaluate the vascular anatomy of patients receiving free perforator flap head and neck reconstruction. We explore the advantages of the technique and its role as a valuable adjunct for the planning and harvesting of perforator flaps.     

游离皮瓣移植修复口腔颌面部缺损的临床效果观察

目的探讨游离皮瓣在修复口腔颌面部缺损中的临床应用价值。方法选择2006年03月—2010年08月中国医科大学口腔医学院口腔颌面外科用游离皮瓣修复口腔颌面部缺损病例168例,前臂游离皮瓣90例,股前外侧游离皮瓣39例,腓骨肌皮瓣31例,背阔肌皮瓣8例。术后观察皮瓣成活率和并发症。结果成功164(97.6%)例,失败4例,患者出现术后早期局部并发症6.5%(11/168),术后皮瓣危象发生率为5.4%(9/168),其中静脉血栓形成66.7%(6/9),手术探查抢救成功率55.6%(5/9),前臂桡侧皮瓣成活率97.8%(88/90);股前外侧皮瓣成活率97.4%(38/39);腓骨肌皮瓣成活率96.8%(30/31);背阔肌皮瓣8例全部成活,随访2～2.5年大部分患者外形及功能满意。结论游离皮瓣修复口腔颌面部缺损的成活率高,前臂皮瓣、股前外侧皮瓣、腓骨肌(皮)瓣、背阔肌皮瓣是修复口腔颌面部缺损的常用皮瓣。     

Maxillary reconstruction using rectus abdominis free flap and bone grafts

We did total maxillectomies for cancer in 22 patients and reconstructed the face with rectus abdominis free flaps and bone grafts. The functional and aesthetic results have been satisfactory. The use of rectus abdominis free flap with nonvascularised bone grafts is a useful technique after excision of the maxilla and orbital floor. It permits a reliable, safe, one-stage reconstruction of complex three-dimensional anatomy with stable functional and aesthetic results.     

28例上颌前牙即刻种植游离软组织瓣移植的临床观察

目的　评估即刻种植同时进行游离结缔组织瓣移植的上颌单颗前牙病例软组织瓣的成活情况及重建效果。方法　2012年12月—2013年5月由同一术者对28名因外伤导致上颌单颗前牙缺失行即刻种植游离结缔组织瓣移植手术,术中不翻瓣拔牙,同期采用非埋入式植入28颗种植体,在硬腭部取瓣,采用游离结缔组织瓣移植行种植体周软组织重建,观察组织瓣成活情况及术后植体软组织重建情况。结果　游离结缔组织瓣愈合良好,临床成活率为96.43%,软组织形态达到预期结果,红色美学评分（PES）分值较高,软组织重建达到了美学效果。结论　上颌单颗前牙即刻种植软组织重建采用游离结缔组织瓣移植安全可靠,且取瓣方便,手术时间短,是其软组织重建的合理选择。     

Oromandibular reconstruction using microvascularized bone flap: report of 1038 cases from a single institution

This retrospective study was performed to review 1038 patients who underwent mandibular reconstruction with free vascularized bone flaps at a single institution between 2006 and 2017. Of these patients, 827 (79.67%) had fibula flaps, 197 (18.98%) had deep circumflex iliac artery perforator (DCIA) flaps, and 11 (1.06%) had scapula bone flaps. The most common pathological diagnosis was ameloblastoma (n = 366, 35.26%), followed by squamous cell carcinoma (n = 278, 26.78%) and osteoradionecrosis (n = 152, 14.64%). Fifty-seven patients (5.49%) had major complications requiring surgical intervention and one patient died of a pulmonary embolism. Venous crisis was the most frequent major complication (n = 20, 1.93%), followed by haematoma (n = 17, 1.64%) and flap necrosis (n = 14, 1.35%). One-stage mandibular reconstruction was preferred whenever possible, as this generally decreases the financial and hospitalization burden. The four-segment method of jaw reconstruction appeared to achieve good aesthetic appearance results in Asian patients and this was not associated with a higher risk of segment ischemia compared with the three-segment method.     

多种组织瓣在口腔颌面部组织缺损中的应用

目的：总结12种组织瓣整复口腔颌面部软组织缺损的临床应用价值、技术特点及适应症。方法：对68例口腔颌面部大、中型组织缺损的患者，立即用带蒂肌皮瓣和游离组织瓣进行舌、口底、面颊部、腮腺区等部位的修复重建，并对效果进行观察。结果：54块带蒂肌皮瓣成功率为96．3％（52／54），使用最多的是胸大肌皮瓣；17块游离组织瓣成功率为88．3％（15／17），使用最多的是前臂游离皮瓣。所用各类组织瓣修复效果良好。结论：用组织瓣立即整复口腔颌面部组织缺损，可及时恢复口腔颌面部功能，对提高患者生存质量起到积极作用。     

Methods and studies of tongue reconstruction

Total and even partial glossectomy could be a major event in the life of a patient. Tongue function is so complicated which makes maintaining normal functions of the tongue such as swallowing and speech and preserving larynx integrity after the surgery is a primary objective of the surgeon. This task is very difficult and the result is not predictable. Recent years, however, there has been interesting developments in microsurgical techniques, and these advancements enable oral and maxillofacial surgeons to achieve better results and improve the quality of their patient′s life. The results even with use of the new technology are still far from perfect. Several reasons may cause variation in the result. Some of them have to do with the patient such as general health and other reasons are due to the method that is used and nature of the defect after the removal of the tumor. This article was undertaken to summarize the various methods and techniques used over the years to restore oral tongue functions after defects.     

Evaluation of swallowing function after intraoral soft tissue reconstruction with microvascular free flaps

This study assessed swallowing function after tumour resection and reconstruction utilizing free vascularized flap closures in patients with oral cancer. Swallowing function was evaluated postoperatively in 23 patients (21 men and 2 women) who had undergone reconstruction with either a lateral upper arm free flap (LUFF, n=16) or a radial forearm free flap (RFFF, n=7). Videofluoroscopy was used to assess tongue mobility and abnormalities of swallowing function.All patients who underwent reconstruction with LUFF or RFFF free flaps had decreased tongue mobility, except for the tip of the tongue. Patients who underwent anterior or posterior resection had greater decreases in tongue mobility than those who underwent medial resection. Swallowing impairment was similar in patients with LUFFs and those with RFFFs. Anterior resection of the oral cavity had a significant negative effect on swallowing function. Silent aspiration occurred in five patients. In conclusion the resection site affected swallowing function, but the type of flap did not, in patients with oral carcinoma, who underwent tumour resection with reconstruction     

MDIC种植体颧骨种植在全上颌骨缺损功能重建中的应用

目的 :研究MDIC种植体在颧骨种植重建全上颌骨缺损的方法及临床效果。方法 :6例肿瘤治疗后全上颌骨缺损的患者 ,应用MDIC种植体在颧骨种植 ,通过种植修复体进行上颌骨缺损功能重建。结果 :重建后患者的面形明显改善 ,修复体固位良好 ,发音及咀嚼功能得到很好的恢复 ,植入的种植体可以实现骨结合并完成种植修复 ,行使功能。结论 :此方法可以实现全上颌骨缺损的功能重建。     

游离腹直肌皮瓣在口腔颌面大型缺损Ⅰ期修复中的应用

目的：探讨应用游离腹直肌皮瓣修复口腔颌面部癌术后大型缺损的可行性。方法：对18例口腔颌面部肿瘤切除术后大型缺损即刻游离移植腹直肌皮瓣修复,对临床资料进行分析和总结。结果：随访3～24个月,18例皮瓣完全成活,成活率100％。结论：腹直肌皮瓣游离移植是修复口腔颌面部大型缺损可靠和理想的方法。