口腔颌面外科学（中山大学）18.整形外科.pptVIP

1/3-1/2: free flap--forearm flap etc pedical flap--submental flap etc Submental flap repairing tongue defect Pectoralis major myocutaneous flap Reconstruction of mandibular defect non vascularized bone graft reconstruction with metal palate combined with or without soft tissue flap vascularized bone graft mangement of condylar process 思考题 游离皮片移植的分类及特点 带蒂皮瓣的分类 骨移植的分类、特点及注意事项 舌缺损修复方法 下颌骨缺损修复方法和适应证 * 胸大肌皮瓣 下斜方肌皮瓣 颈横动 脉浅降 支 下斜方肌皮瓣 颏下动脉岛状肌皮瓣 皮瓣转移的适应证 带蒂皮瓣移植的注意事项 术前 应考虑皮瓣及缺损部位之血液循环情况、部位、大小、长短、转移次数、方法，以及转移后血管蒂是否可能发生扭曲现象等 切取皮瓣之前 用美蓝在皮肤上按需要画出外形，一般应比缺损处稍大，以预防皮瓣转移后发生收缩 切取皮瓣时 按需要厚度注意始终保持在同一水平面上切取，不可高低不平；操作要轻巧，避免任何不必要的损伤组织的操作；在颌面部切取皮瓣时，切不可损伤面神经 皮瓣缝合前 充分止血，缝毕要用生理盐水将血块冲干净，以免引起血肿而感染；缝合后还要适当加压包扎，但不能压迫蒂部。 皮瓣转移后 将供皮区创面直接缝合或用中厚断层游离皮片移植（颌面部最好作全层皮片移植），不要有创面暴露引起感染 需断蒂者 术后14～21d进行 Fibula graft The vascular pedicle of the blood vessels was constant, the diameter of the vessel was large, the success rate of vascular anastomosis was high. Sufficient length was provided for bone mass and the length of the fibula was 25cm. Advantages of free fibula transplantation A nutrient branch of fibular artery come into the middle 1/3 of the fibula, providing blood to the bone marrow. It provides the anatomic basis for the reconstruction of the mandibular . The fibula has solid density, which is very beneficial to implants. Fibulae capitulum could be acted as mandibular condyle Disadvantages of free fibula transplantation Diameter of fibula is only 1.2 cm, it is insufficient to reconstract height of mandible,. deep peroneal nerve was injuried on occasionally. the fibula is one part of the ankle joint and its ligaments. Fibular resection should be stressed limited on 3 / 4, and resection of whole fibular should not be done, otherwise it may bring to the consequences of instability of ankle joint Cartilage graft source：costal cartilage nasal septal cartilage auricular cartilage Biological material Titanium plate, silic