Perioperative findings and complications of non-vascularised iliac crest graft harvest: The experience of a Nigerian tertiary hospital

Donor- and recipient-site morbidity of vascularized fibular and iliac flaps for mandibular reconstruction: A systematic review and meta-analysis

The aim of this article is to evaluate the early and late morbidities of the donor- and recipient-site in patients undergoing mandibular reconstruction using either vascularized fibular flap (VFF) or vascularized iliac flap (VIF). Electronic databases, including PubMed, Web of Science, Cochrane Central and Embase, were explored for literature published until October 2020. A total of twenty-four articles reporting complications following mandibular reconstruction surgery with follow-up periods ranging from six to 63 months were selected based on the exclusion criteria. For each research, the JBI Critical Assessment Tool and the ROBINS-I Tool were used to analyze the methodological quality and the risk of bias. A single-arm meta-analysis was performed to have a synthesized analysis of the donor- and recipient-site early and late morbidities. Results showed that the early morbidities in VFF group ranged from 3% to 12%, and the late morbidities in VFF group ranged from 5% to 67%. In VIF group, the early morbidities ranged from 3% to 16%, and the donor-site late morbidities ranged from 6% to 43%. Complications with the top three morbidities in the VFF group were: chronic sensory disturbances at the donor-site (67%), malocclusion (22%) and chronic lower limb weakness (20%); and in the VIF group were: chronic sensory disturbances at the donor-site (43%), chronic pain at the donor-site (26%), chronic gait disturbance (20%). Further controlled clinical trials are needed to assess the long-term outcome of VFF or VIF grafting.

The Strategy of Delayed Reconstruction of the Mandible in War Injuries

The most common causes of mandibular defects are ablative surgery of benign or malignant tumors, severe trauma, inflammatory diseases, and osteoradionecrosis. War injuries are another cause for mandibular defect. Reconstruction of the mandible is considered a challenge to the maxillofacial surgeon due to the accompanying functional and cosmetic importance. The object of this article was to show the role of nonvascularized bone graft in the reconstruction of segmental defect of the mandible resulted from projectiles and its snags. Seventeen patients underwent reconstruction of defect in the body of the mandible using non-vascularized iliac bone graft,in sixteen patients the grafts were fixed by reconstruction plate and in one by stainless-steel wire. In the emergency phase in which life-saving measures were done, in the immediate phase, treatments of associated facial and systemic injuries were carried out. The delayed phase includes the reconstruction of the residual defects and rehabilitation. A total of 17 male patients with a mean age of 34.5 years underwent reconstructive surgery, the time lapse between the injury and the delayed phase of treatment ranged from 20 days to 3 months. The size of the defects ranged from 4 to 7 cm. Treatment was considered successful in 15 patients (88.2%) in whom the grafts were incorporated to mandible with improvement of facial contour and symmetry and satisfactory occlusion of the remaining teeth. Nonvascularized bone graft is considered a feasible option for the reconstruction of a relatively small mandibular defect, especially in ascetic conditions for its role in improving facial appearance and to less extent functional benefit and more advanced method for the reconstruction needed to be introduced especially in war injuries.

Reconstruction of Continuity Defects of the Mandible with Non-vascularized Bone Grafts. Systematic Literature Review

BACKGROUND

The use of NVBG for mandibular defects seems to be gradually giving way for more advanced reconstructive techniques but it has the advantages of shorter operating time and lesser amount of blood loss. The aim of this study was to review the available data on the success and failure rates of use of NVBG and factors associated with failure.

METHOD

Studies published from 1978 to 2014 regarding the use of NVBG were searched. Most important information was graft success and failure outcomes. Information on graft success with particular focus on large defects was extracted and the quality of papers was rated. Defects > 6cm were considered long defects.

RESULTS

Twenty publications were included in this review. The quality of the studies was low and there was high heterogeneity. All articles reported high graft success rates ranging from 67 to 100%. Success in defects > 6cm was considerable, the range was 72-100%. Three main factors were associated with failure; these were defect length, fixation method and infection. Infection contributed the highest complication rate which was 48.2%.

CONCLUSION

NVBG seems to be appropriate for mandible reconstruction when there is vascular recipient bed and sufficient soft tissue cover and mucosal lining are achievable.