颌骨肿瘤或放射性骨坏死通常会导致广泛的复合缺损，包括口内，骨和口外组织。单个皮瓣不能同时提供足够的骨和软组织。自由襟翼的组合可能是克服挑战的前瞻性方法。该研究旨在评估虚拟手术计划（VSP）和3D打印辅助腓骨隔皮瓣（FOSCF）联合股前外侧皮瓣（ALT）重建口下颌区广泛复合缺损的疗效。对8例使用FOSCFs联合ALT进行重建的患者进行了回顾性分析。手术切除病变后,我们获得了口腔内软组织缺损的平均值，骨头,口外软组织,即,为42.7cm2，96毫米，68.9cm2。平均手术时间为712.5分钟。共收集并移植了16个皮瓣8例，所有人都成功地生存了下来。术后,并发症表现为局部口腔内感染2例，另外2例肌间静脉血栓形成，2例患者肺部感染。两名患者不幸经历了肿瘤复发，分别在术后12个月和3个月。对于幸存的6名患者，平均随访时间为12.2个月。关于患者满意度，一个人对下颌骨的轮廓表示不满，还有两个表现出适度的三端子。客观评估确定了1例口腔失禁和2例观察到外部皮瓣挛缩。所有8名患者都恢复了咀嚼功能，并且能够在术后一个月内食用软饮食。在我们的研究中，VSP/3D打印辅助的FOSCFs结合ALTs可以安全地重建广泛的复合组织缺损，具有理想的美学和功能效果，它是选择涉及多种组织类型的缺损患者的可靠选择。然而,这种方法的好处需要更多的案例来验证。
Oromandibular tumors or osteoradionecrosis often lead to extensive composite defects encompassing intraoral, bone and extraoral tissues. A single flap cannot simultaneously offer sufficient bone and soft tissue. The combination of free flaps could be a prospective approach to overcome the challenge. The
study aims to assess the efficacy of virtual surgical planning (VSP) and 3D printing assisted fibula osteoseptocutaneous flap (FOSCF) combined with anterolateral thigh flaps (ALT) in reconstructing extensive composite defects in the oromandibular region. A retrospective analysis was conducted on 8 patients who underwent reconstruction using FOSCFs combined with ALTs. Post-surgical excision of the lesions, we obtained mean values for the defects of intraoral soft tissue, bone, extraoral soft tissue, namely, being 42.7 cm2, 96 mm, and 68.9 cm2. The mean surgical procedures took 712.5 min. A total of 16 flaps were harvested and transplanted for the 8 patients, with all successfully surviving. Postoperatively, complications manifested as localized intraoral infections in 2 cases, intermuscular vein thrombosis in another 2 cases, and pulmonary infections in 2 patients. Two patients unfortunately experienced tumor recurrence, at 12 and 3 months post-operation respectively. For the surviving 6 patients, the average follow-up period was 12.2 months. Regarding patient satisfaction, one expressed dissatisfaction with the contour of the mandible, and two exhibited moderate trismus. Objective assessments identified 1 case of oral incontinence and 2 cases where external flap contractures were observed. All 8 patients experienced restoration of masticatory function and were able to consume a soft diet within a month post-surgery. VSP/3D printing assisted FOSCFs combined with ALTs can be performed safely to reconstruct the extensive composite tissue defects in our
study, with desirable esthetic and functional results, and it is a reliable option in selecting patients with defects involving multiple tissue types. However, the benefits of this method needed more cases to validate.
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