Objective： To evaluates mandible reconstruction by free vascularized fibular flap with special emphasis on the immediate complications. Methods：The clinical data of 63 patients were reviewed, 35 male and 28 female（...Objective： To evaluates mandible reconstruction by free vascularized fibular flap with special emphasis on the immediate complications. Methods：The clinical data of 63 patients were reviewed, 35 male and 28 female（age range 16 to 73 years）. Aesthetic and functional outcomes were evaluated by follow-up and/or telephone conversation. Results：Among the 63 fibular flaps, 29 were osteocutaneous flaps with one or two skin islands. All the flaps were surviving well and the success rate was 100%. Long term donor site disability was not recorded for any patient. Thirty-one patients responded for aesthetic and functional evaluation, 20 cases（64.5%） reported their facial appearance as excellent or good, 11 （35.48%） felt fair; 14 cases （45%） could eat unrestricted diet, 17（55%） could eat soft diet; 21 cases were（67.67%） speech normal, 10（22.33%） speech intelligible. Conclusion：Free fibular flap reflects good functional and esthetic results with a high degree of consistency, and acceptable level of complications, and we strongly believe the vascularized fibular flap is the first choice for mandibular reconstruction.展开更多
Purpose:To assess the effectiveness of two-stage treatment with the fibular sliding technique in chronic infected nonunion of the tibia.Methods:The study included patients who were diagnosed with long-term chronic inf...Purpose:To assess the effectiveness of two-stage treatment with the fibular sliding technique in chronic infected nonunion of the tibia.Methods:The study included patients who were diagnosed with long-term chronic infected tibial nonunion following trauma and treated with the two-stage technique between January 2010 and November 2017.Patients with(1)intra-articular fractures of the distal third of the tibia and fibula,(2)pathological fracture resulting in bone loss or(3)neurological and vascular pathologies of the limbs were excluded.The operation consisted of two stages and the main goal in the first stage was to control the infection and in the second stage to control the healing of the bone.Functional&radiographic results and complications were evaluated according to Paley's criteria.Results:The patients comprised 14 males and 5 females with a mean age of 37.4 years(range,21-52 years).Patients were followed up for an average of 27 months(range,15-38 months).The microorganisms produced from these patients were Staphylococcus aureus in 13 patients,Pseudomonas aeruginosa in 4 patients and no bacteria in 2 patients.After the first stage operation,superficial skin necrosis developed in 1 patient.In another patient,there was a persistent infection,although union was achieved.For the entire patient group,union was observed at the end of 7.44 months(range,7-11 months).Based on Paley's criteria,there were 16(84.2%)patients with excellent scores,2(10.5%)good scores and 1(5.3%)fair scores radiologically;while regarding the tibial function,15(78.9%)patients had excellent scores,3(15.8%)good scores,and 1(5.3%)fair scores.No patients had poor radiological or functional score.Conclusion:Two-stage treatment can be considered as an alternative for fractures in regions that are susceptible to many and persistent complications,such as the tibia.This technique has the advantages of short operation time,minimal blood loss,no excessive tissue damage and not very technique-demanding(a short learning curve with no requirement for an experienced team).展开更多
基金Science Fund of Department of Public Health of Jiangsu Province(ZK200209)
文摘Objective： To evaluates mandible reconstruction by free vascularized fibular flap with special emphasis on the immediate complications. Methods：The clinical data of 63 patients were reviewed, 35 male and 28 female（age range 16 to 73 years）. Aesthetic and functional outcomes were evaluated by follow-up and/or telephone conversation. Results：Among the 63 fibular flaps, 29 were osteocutaneous flaps with one or two skin islands. All the flaps were surviving well and the success rate was 100%. Long term donor site disability was not recorded for any patient. Thirty-one patients responded for aesthetic and functional evaluation, 20 cases（64.5%） reported their facial appearance as excellent or good, 11 （35.48%） felt fair; 14 cases （45%） could eat unrestricted diet, 17（55%） could eat soft diet; 21 cases were（67.67%） speech normal, 10（22.33%） speech intelligible. Conclusion：Free fibular flap reflects good functional and esthetic results with a high degree of consistency, and acceptable level of complications, and we strongly believe the vascularized fibular flap is the first choice for mandibular reconstruction.
文摘Purpose:To assess the effectiveness of two-stage treatment with the fibular sliding technique in chronic infected nonunion of the tibia.Methods:The study included patients who were diagnosed with long-term chronic infected tibial nonunion following trauma and treated with the two-stage technique between January 2010 and November 2017.Patients with(1)intra-articular fractures of the distal third of the tibia and fibula,(2)pathological fracture resulting in bone loss or(3)neurological and vascular pathologies of the limbs were excluded.The operation consisted of two stages and the main goal in the first stage was to control the infection and in the second stage to control the healing of the bone.Functional&radiographic results and complications were evaluated according to Paley's criteria.Results:The patients comprised 14 males and 5 females with a mean age of 37.4 years(range,21-52 years).Patients were followed up for an average of 27 months(range,15-38 months).The microorganisms produced from these patients were Staphylococcus aureus in 13 patients,Pseudomonas aeruginosa in 4 patients and no bacteria in 2 patients.After the first stage operation,superficial skin necrosis developed in 1 patient.In another patient,there was a persistent infection,although union was achieved.For the entire patient group,union was observed at the end of 7.44 months(range,7-11 months).Based on Paley's criteria,there were 16(84.2%)patients with excellent scores,2(10.5%)good scores and 1(5.3%)fair scores radiologically;while regarding the tibial function,15(78.9%)patients had excellent scores,3(15.8%)good scores,and 1(5.3%)fair scores.No patients had poor radiological or functional score.Conclusion:Two-stage treatment can be considered as an alternative for fractures in regions that are susceptible to many and persistent complications,such as the tibia.This technique has the advantages of short operation time,minimal blood loss,no excessive tissue damage and not very technique-demanding(a short learning curve with no requirement for an experienced team).
