| Objective:To evaluate the application of vascularized free fibula flap(FFF)aided by preoperative computed tomography angiography localization for reconstruction of postoperative defects after ameloblastoma resection.Methods:(1)A total of 22 patients with AM underwent concurrent reconstruction using FFF after resection were retrospectively included between 2009 January to 2016 November.Among them,15 patients were underwent preoperative CTA localization to map and detect the peroneal vessels and its perforators.The diameter,course and origin of the peroneal artery and its perforators were measured and analyzed statistically.A diagnostic test was designed to evaluate the accuracy of CTA for preoperative assessment of peroneal artery.(2)CAD/CAM technique was used to simulate the maxillofacial resection and reconstruction,making the personalized jaw model and the surgical template.The patients were followed-up about half a year to 5 years to observe the survival rate of FFF,function and appearance of recipient area and regional complications after operation.Results:(1)The survival rate of all the flaps was 100%(22/22),and 4 of them carried skin paddles whose size respectively were 3.0*5.0cm,3.0*4.0cm,3.5*4.5cm and 6.5*3.0cm.The length of the fibulas were 7.5-21.5cm and the average was 13.4cm.During follow-up,the morphological characteristics of oral and maxillofacial was satisfactory,and the relationship of the occlusion was good.The wound of the donor-site area of the calf was well hidden,CT showed that the titanium plates and nails were well retained and the shape of the reconstructed mandibular was basically symmetrical with the contralateral side.however,6 cases(27.3%)had calf disfunction like limb movement limitation.(2)In our study,30 sides(100%)PA(15 on the left,15 on the right)were detected in 15 patients by using CTA.The outer diameter of the origin of the PA was(4.41±0.81)mm.The vertical distance from the origin of PA to FA was(41.91±6.59)mm.The vertical distance from the origin of perforator to FA was(79.06±17.56)mm.There was no significant difference between the diameter of the origin of PA(P>0.05).The total 27 perforators were found in 25 patients by using CTA;1 perforator was found in 5 cases(33%),2 perforators were found in 6 cases(40%),3 perforators were found in 3cases(20%),and 0 perforator were found in leases(7%).Among the 27 perforators,10(37.03%)were septocutaneous and 17(62.96%)were myocutaneous.In origin of PA,13(86.7%)were type I and 1(6.7%)were type?,1(6.6%)were type IV by using preoperative CTA;While the intraoperative exploration turned out that 12(80%)were type 1,1(6.6%)were type ? and 2(13.4%)were type ?.There is no significant difference between preoperative CTA detection and introperative anatomy.The accuracy and sensitivity of CTA detection was respectively 80%and 86.7%.The difference between preoperative CTA and intraoperative exploration has no statistical significance.Conclusion:1.Ameloblastomas are characterized by an aggressive potential for local invasion and have a high recurrent rate after resection.The choice of treatment must be adapted to macroscopic,histological types of each tumor and age of every patient,2.The vascularized free fibula flap is an ideal alternative for the reconstruction of jaw and soft tissue defects after ameloblastoma radical resection because of its adequate blood supply,strong infection resistence,high quality of cortical bone and good plasticity.3.Preoperative CTA could accurately display the course,diameter and location of the peroneal artery and its perforators to exclude the anatomical variants and lesion of lower limb vascular.lt can provide valuable information to design and harvest the free fibula myocutaneous flap.However,the accuracy of CTA in the diameter and type of peroneal artery and its perforators needs to be further studied. |
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