Abstract:

Objective The purpose of this study was to explore the application value of digital surgery in the reconstruction of mandibular composite defects with a chimeric deep circumflex iliac artery perforator flap (DCIAPF). Methods Six patients with complex defects within half of the mandible underwent reconstruction using DCIAPF from January 2019 to January 2020 in Shenzhen People’s Hospital. Doppler was used to locate the deep iliac circumflex artery, the range of mandibular osteotomy was designed, and DCIAPF was used to repair the mandibular composite under the guidance of the guide plate during the operation. Twelve months postoperatively, the facial shape, jaw height, and occlusal relationship were evaluated.Results DCIAPF was harvested successfully in 6 patients, and the heights of all alveolar ridges and occlusal function of patients were significantly restored, without pain or snapping in the temporomandibular joint area. Conclusion The blood supply of DCIAPF is rich, and soft-bone tissue is sufficient for the reconstruction of mandibular composite defects. Combined with digital surgery, the accuracy and safety are improved.

Key words: digital surgery, deep circumflex iliac artery, perforator flap, chimeric flap, mandibular defect, reconstruction, precision medicine

摘要：

目的 探讨数字化外科引导旋髂深动脉穿支嵌合瓣在下颌骨复合性缺损重建中的应用价值。方法 选取2019年1月至2020年1月在深圳市人民医院口腔颌面外科行数字化引导旋髂深动脉穿支嵌合瓣重建下颌骨半侧以内复合性缺损的6例患者,术前使用多普勒定位旋髂深动脉,利用数字化软件设计下颌骨截骨范围,设计并制作截骨导板、重建导板,术中在导板引导下,应用旋髂深动脉穿支嵌合瓣修复下颌骨复合缺损。术后随访12个月,评估患者面部外形、颌骨高度、咬合关系及供区并发症情况。结果 6例患者均成功制备了旋髂深动脉穿支嵌合瓣,髂骨肌皮瓣均存活。患者的面型恢复满意,未出现颞下颌关节区疼痛及弹响,重建下颌骨的宽度及高度均满意,咬合关系均正常。结论 旋髂深动脉穿支嵌合瓣血运丰富且骨量充足,可以很好地重建下颌骨复合缺损,结合数字化外科,提高了重建下颌骨缺损的精确度及安全性。

关键词: 数字化外科, 旋髂深动脉, 穿支皮瓣, 嵌合皮瓣, 下颌骨缺损, 修复重建, 精准医学