유리 혈관화 비골판을 이용한 하악골 재건의 임상적 연구

Mandibular reconstruction with free vasularized fibular flaps

With advent of microsurgical tissue transfer, various vascularized bone composite tissues from the available donor sites have been used for the mandibular reconstruction. Among these, the fibular flap has been reported to have many advantages over the others. The clinical data of 14 consecutive cases, in which free vascularized fibular graft with or without skin paddle has been used to reconstruct defective mandibles, including the operative and postoperative results were assessed. In seven patients, the mandibular defect was reconstructed secondarily and the others, primarily. The average length of the fibula segment harvested was 17.7cm, with a range of 12~22cma. In 10 flaps, a skin paddle was also harvested(average size of it was 7.1×3.4cm). The number of wedge osteotomies ranged from 0 to 4, with an average of 1.67. The donor wound was closed directly except three cases. Vein grafts were performed in five cases to lengthen the pedicle. In two cases out of ten where the skin paddle was included, the skin was partially appearances were fair to excellent, with the mouth opening ranges 21 to 50mm. Immediately after the operation, all the patients showed some minor identifiable weakness of the flexor hallucis longus action. Free vascularized fibular flap provided a long length of rigid, strong cortical bone which was very similar to the mandible in dimensions. The skin paddle was reliable in contrast to the general opinion that it is unreliable. Furthermore, the donor site morbidity was low.