血管化游离皮瓣口腔重建：牙科功能结局的叙述性综述。

文献信息

中文摘要

背景： 由肿瘤切除、创伤或其他获得性病变导致的口腔软硬组织缺损，通常需要复杂重建以恢复形态和功能，而血管化游离皮瓣为广泛组织替代提供了可靠方法。尽管其在口腔颌面重建中广泛应用，但其对普通牙科实践的意义仍不十分明确，尤其是在言语、咀嚼、吞咽、牙科修复和长期维护方面。本叙述性综述旨在综合血管化游离皮瓣重建后功能和牙科结局的当前证据，重点强调其对参与长期护理的普通牙科医生的临床相关性。方法：在主要生物医学数据库中进行了全面文献检索，纳入2015年1月至2026年3月发表的英文文献。纳入报告血管化游离皮瓣重建后功能、牙科修复或患者报告结局的研究，以及提供相关临床建议的精选综述和指南文章。最终叙述性综合包括60项原始研究和13篇综述/指南文章。结果：尽管血管化游离皮瓣能够可靠重建复杂口腔缺损，但功能结局因缺损特征、皮瓣选择和康复而异。薄而柔韧的皮瓣有助于在组织活动度重要的部位进行重建，而血管化骨皮瓣为种植体支持的牙科修复提供基础。牙种植体和修复重建对恢复咀嚼和生活质量有重要贡献；然而，皮瓣解剖改变、种植体周围并发症、卫生维护受限以及放疗相关影响构成重要的长期挑战。患者报告结局进一步表明，成功的解剖重建并不总是与完全功能恢复相对应。结论：成功的游离皮瓣重建不仅限于皮瓣存活，还延伸到持续的功能和牙科修复。普通牙科医生在预防保健、修复和种植体周围维护、监测以及长期多学科随访中发挥重要作用。需要标准化的功能和患者报告结局测量指标，以加强未来证据并指导牙科管理。

英文摘要

Oral soft- and hard-tissue defects resulting from oncologic resection, trauma, or other acquired conditions often require complex reconstruction to restore form and function, with vascularized free flaps providing a reliable approach for extensive tissue replacement. Despite their widespread use in oral and maxillofacial reconstruction, their implications for general dental practice remain less clearly defined, particularly regarding speech, mastication, swallowing, dental rehabilitation, and long-term maintenance. This narrative review aims to synthesize current evidence on functional and dental outcomes following vascularized free flap reconstruction, with emphasis on their clinical relevance for general dental practitioners involved in long-term care. A comprehensive literature search was conducted across major biomedical databases for English-language publications from January 2015 to March 2026. Studies reporting functional, dental rehabilitation, or patient-reported outcomes following vascularized free flap reconstruction were included, together with selected review and guideline articles providing relevant clinical recommendations. The final narrative synthesis comprised 60 primary studies and 13 review/guideline articles. Although vascularized free flaps provide reliable reconstruction of complex oral defects, functional outcomes vary according to defect characteristics, flap selection, and rehabilitation. Thin, pliable flaps facilitate reconstruction where tissue mobility is important, whereas vascularized osseous flaps provide a foundation for implant-supported dental rehabilitation. Dental implants and prosthetic rehabilitation contribute substantially to restoration of mastication and quality of life; however, altered flap anatomy, peri-implant complications, restricted hygiene access, and radiotherapy-related effects present important long-term challenges. Patient-reported outcomes further indicate that successful anatomical reconstruction does not invariably correspond with complete functional recovery. Successful free flap reconstruction extends beyond flap survival to sustained functional and dental rehabilitation. General dental practitioners have an important role in preventive care, prosthetic and peri-implant maintenance, surveillance, and long-term multidisciplinary follow-up. Standardized functional and patient-reported outcome measures are needed to strengthen future evidence and guide dental management.