摘要
目的探讨应用三种游离组织瓣(前臂皮瓣、腹直肌皮瓣和腓骨复合组织瓣)行上颌骨缺损修复的临床应用价值及不同组织瓣的适应证。方法对65例应用三种游离组织瓣行上颌骨缺损修复的患者进行回顾性研究,分析原发疾病、上颌骨缺损情况、游离组织瓣选择、术后并发症及术后随访功能恢复情况,探讨不同游离组织瓣行上颌骨缺损重建的适应证。结果65例患者中,男性37例,女性28例,年龄15～86岁,中位年龄45.0岁;其中炎症1例,创伤2例,放射性骨坏死2例,良性肿瘤10例,恶性肿瘤50例。按照Brown上颌骨缺损分类,Ⅰ类(上颌骨低位切除)为4例,Ⅱ类(上颌骨次全切除)为36例,Ⅲ类(上颌骨全部切除)为24例,Ⅳ类(上颌骨扩大切除)为1例。游离组织瓣应用情况:腹直肌皮瓣32例,腓骨复合组织瓣25例和前臂皮瓣8例。所有组织瓣均经血管吻合,其中1例腹直肌皮瓣坏死,组织瓣移植成功率达98.5%。术后功能均基本恢复正常,口鼻腔及口腔上颌窦封闭完全,均能经口腔进食,术后语音清晰,无发音不清。对三种游离组织瓣患者的年龄和上颌骨缺损类型进行统计学分析,表明差异有显著性(p<0.05)。结论游离组织瓣在上颌骨缺损修复中能取得令人满意的结果,但三种游离组织瓣各有其适应证,应根据上颌骨缺损的具体情况和病人的全身状态来进行选择。
Objective To evaluate the use and indications of forearm flap,rectus abdominus myocutaneous flap and fibula osteocutaneous flap used for reconstructing the maxillary defects.Methods Sixty-five consecutive cases of maxil-lary reconstruction with free flaps were reviewed.All the clinical data including primary diseases,the type of maxillary de-fect,the select of free flap,perioperative complications and the follow-up were analyzed.Results All the cases under-went the three free flaps reconstruction of the maxillary defects.50cases with malignant tumors,10cases with benign tu-mors,2cases with radioosteonecrosis,2cases with trauma and1case with inflammation.Only one flap failure was noted.The successful rate was98.5%.All patients had oral diet with good separation of the oral and sinonasal cavities,and had no difficulty in speech intelligibility.The age and the type of maxillary defects in different free flap groups were analyzed statistically,the results indicated there were significant difference in the three free flap groups(P<0.05).Conclusions The three free flaps can be used to reconstruct maxillary defects,which can improve patient's outlook and function and contribute to the overall quality of life.The forearm flap is suitable for the old patients with small maxillary defect.The fibula osteocutaneous flap is an ideal choice for ClassⅠandⅡmaxillary defect reconstruction.The rectus abdominus myocutaneous flap is fitted for large maxillary defects.
出处
《中国口腔颌面外科杂志》
CAS
2003年第1期9-12,共4页
China Journal of Oral and Maxillofacial Surgery
关键词
游离组织瓣
上颌骨缺损
修复
前臂皮瓣
腹直肌皮瓣
腓骨复合组织瓣
Maxillary Defects
Free Flaps
Reconstruction
Fibula Osteocutaneous Flap
Rectus Abdominus Myocuta-neous Flap
Forearm Flap
