Vascularized Combined with Nonvascularized Fibula Flap for Mandibular Reconstruction
| Autor: | Hongyu Yang, Shiyue Shen, Huijun Yang, Bo Lin |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_treatment
Mandible Surgical Flaps Crown (dentistry) 03 medical and health sciences 0302 clinical medicine Alveolar ridge medicine Humans Fibula Mandibular reconstruction 030223 otorhinolaryngology Retrospective Studies Orthodontics Bone Transplantation business.industry 030206 dentistry General Medicine Fibula flap Resorption Otorhinolaryngology Surgery Implant Mandibular Reconstruction business |
| Zdroj: | Journal of Craniofacial Surgery. 30:e365-e369 |
| ISSN: | 1049-2275 |
| DOI: | 10.1097/scs.0000000000005379 |
| Popis: | Background Repair of long-span mandibular defects with vascularized free fibular grafts is now a routine procedure. Vertical discrepancy between a graft segment and the occlusal plane can be resolved through several options, including delayed onlay bone graft, iliac bone reconstruction, fibula distraction, and double-barrel fibula flap grafts. The present study (level of evidence: level IV, case series) introduces a new method for mandibular augmentation, wherein a vascularized fibular segment was used to simulate the superior alveolar ridge of the neomandible, whereas a nonvascularized fibular segment was used to reconstruct the inferior border. Methods Patients who underwent mandibular reconstruction with this technique between January 2014 and May 2017 were retrospectively reviewed for complications, vertical height, bone resorption rates, and crown to implant (C/I) ratios. Results The study included 10 patients. Flap loss occurred in 1 patient. A sufficiently long vascular pedicle could be maintained when the average fibular length was up to 15.3 cm to reconstruct long-span mandibular defects. Mean height of the neomandible at 2 weeks and 1 year after surgery was 34.1 and 29.4 mm, respectively. Mean resorption rates of vascularized and nonvascularized fibulas were 10.3% and 3.4%, respectively, at 1 year after surgery. Dental implants were placed in 4 patients with a mean C/I ratio of 1:1.15. Conclusion The present method to reconstruct the alveolar ridge and basal portion of the mandible with vascularized and nonvascularized fibular flaps was safe and effective. It provided sufficient vertical height for lip support and implantation as well as adequate length for long-span mandibular reconstruction. |
| Databáze: | OpenAIRE |
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