遊離腓骨皮弁を利用した上顎再建における骨・血管配置シミュレーション

抄録

　　In maxillary reconstruction, it is necessary to arrange several bone segments three-dimensionally in a narrow area while avoiding kinking or obstruction of the vascular pedicle. Precise osteotomy and bone placement will result in more accurate reconstruction; however, the pedicles will be shorter and less likely to reach the cervical recipient vessels.
　　Therefore, we visualized the bone arrangement and reach of blood vessels for maxillary defects using a free fibular flap by computer simulation. We investigated the types of defects in which the vascular pedicles reach the neck sufficiently.
　　Using 3D-CT data of the maxilla and fibula, simulated reconstruction of maxillary defects (Brown ClassⅡb, Ⅱd, Ⅲb, Ⅲd) with the fibula was performed using computer software. We investigated whether the base of the pedicle reached the cervical recipient artery when bone fragments were placed on the alveolar arch, zygomatic eminence, and infraorbital margin in each defect.
　　The vascular pedicle reached the neck in Ⅱb, Ⅱd, and parts of Ⅲb, but not in parts of Ⅲb and Ⅲd. In the Ⅲb defect, the pedicle did not reach the neck when the alveolar arch was reconstructed.
　　A Ⅲb defect may be the limit of reconstruction using a fibula flap alone when arranging the fibula and blood vessels, whose main purpose is reconstruction of the alveolar arch.