Intraoperative planning and inset principles of fibula osteoseptocutaneous flap in compound or composite oromandibular defect reconstruction

Yıl 2006, Cilt: 16 Sayı: 4, 145 - 154, 27.08.2006

Betül Gözel Ulusal Ali Engin Ulusal Ming Huei Cheng Fun Chan Weı

Öz

Objectives: The use of free fibular osteocutaneous flap was evaluated in the reconstruction of com­ pound and composite mandibular defects.Patients and Methods: The study included 30 patients 27 males, 3 females, mean age 52.6 years; range 42 to 66 years who received free osteoseptocutaneous fibular flap for the reconstruction of compound or com­ posite oromandibular defects following surgical tumor ablation. Five patients with extensive skin defects accompanying lateral mandible and oral defects also received free anterolateral thigh perforator flap. Other patients were treated with conventional fibular osteocu­ taneous flap or its chimeric form. The mean follow-up period was 19.4 months range 8 to 38 months .Results: With the applied technique, a successful functional and aesthetic restoration was achieved with- out total flap failure and with minimal donor site morbidity. Infection and fascial abscess encountered in one patient were treated with debridement and antibi- otictherapy. İn one patient who developed osteonecro- sis in the neomandibula, the plate was removed and debridement was performed in the 13th month.Conclusion: By appropriate flap planning and placement, reconstruction of large oromandibular tumors with osteocutaneous fibular flaps provides successful functional and aesthetic restoration.

Anahtar Kelimeler

Fibula/transplantation, mandible/surgery, sur­gical flaps/methods

Birleşik ya da kompozit oromandibüler defektlerin fibula osteoseptokutanöz fleple rekonstrüksiyonunda intraoperatif planlama ve flep yerleştirme prensipleri

Öz

Amaç: Birleşik ve kompozit mandibula defektlerininrekonstrüksiyonunda serbest fibula osteoseptokutanöz flebin kullanımı değerlendirildi.Hastalar ve Yöntemler: Cerrahi tümör ablasyonusonrasında birleşik ve kompozit oromandibüler defektler için serbest fibula osteoseptokutanöz flep kullanılan 30 hasta incelendi. Lateral mandibula ve oral defekte geniş cilt eksizyonunun eşlik ettiği olgularda n=5 ikinci bir flep olarak serbest anterolateral uylukperforatör flep uygulandı. Diğer olgularda konvansiyonel serbest fibula osteoseptokutanöz flep ya dakaymerik flep formu kullanıldı. Ortalama izlem süresi 19.4 aydı dağılım 8-38 ay .Bulgular: Uygulanan teknikle izlem süresi içindetotal flep kaybı görülmedi ve başarılı estetik vefonksiyonel restorasyon elde edildi. Donör alanmorbiditesi minimaldi. Bir olguda gelişen enfeksiyon ve fasiyal apse debridman ve antibiyotik tedavisi ile düzeldi. Bir olguda neomandibulada osteonekroz görülmesi üzerine 13. ayda plak çıkarıldıve debridman yapıldı.Sonuç: Geniş oromandibüler tümörlerin osteokutanöz fibula flebiyle rekonstrüksiyonunda doğru bir flepplanlaması ve yerleştirilmesiyle başarılı bir fonksiyonel ve estetik restorasyon sağlanabilir

Anahtar Kelimeler

Fibula/transplantasyon, mandibula/ cerrahi, cerrahi flep/yöntem.

Kaynakça

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