Correction: Success of the Orbicularis Oculi Myocutaneous Vertical V-Y Advancement Flap for Upper Eyelid Reconstruction

Abstract

Sir: The advantages of autogenous bone graft over manufactured bone materials have been well described. Bone removal can be performed by burr, chisel, bone curette, trephine, and bone filter.1 Bone filters have been developed for collecting autogenous bone debris for the purpose of grafting procedures in craniofacial surgery. Morbidity associated with different graft-harvesting techniques has increased the need to find alternative sites. When small amounts of bone graft are needed, bone particles collected by bone filters can be considered an alternative way of obtaining a bone graft.2 The major advantage is the lack of donor-site morbidity. To harvest the maximum amount of dust, a new technique was conceived and used. A small canister with two outlets in the lid is placed between the suction unit and the metallic tip at the end. A copious amount of irrigation is used with a bulb syringe and a craniotome to avoid damage caused by the heat generated. The bone dust is sucked continuously with the suction tip and collected in the small canister. The bone dust settles at the bottom of the container and the irrigation saline is drained. Excess fluid is further drained from the collected dust using dust collector mesh, and the resulting paste is used to fill the bony irregularities (Fig. 1).Fig. 1.: Canister with inlet and outlet in the lid and mesh bone dust collector.The dust has been used to fill full-thickness defects in the skull with good results, and it has been used as a paste to fill irregularities in reconstructions.3 The bone dust has usually been collected using a flat-bladed Ashe periosteal elevator, but this is time consuming, and inevitably some bone dust is lost. A simple teaspoon has also been used for the same purpose. A simple curved frame bone dust collector mesh was used for many years to collect the graft while using a craniotome. The curved frame was designed to fit any area of skull, and thus little dust was lost.4 It is important that a copious amount of irrigation is maintained constantly and the craniotome is run at a moderate speed. In this way, the drilling temperature is kept below 47ºC.5 This is done to avoid damage to the bone regeneration cells. This technique allows us to collect large amounts of bone dust in more efficient manner. This is a very safe and efficient method of obtaining good material with which to fill bony irregularities or defects without spending extra time and effort during surgery. There is no donor-site morbidity or extra anesthesia time and no extra cost to the patient. Gopal Malhotra, M.S., M.Ch., F.R.C.S. Arunesh Gupta, M.S., M.Ch. Ian T. Jackson, F.R.C.S., F.R.A.C.S., D.Sc. Department of Craniofacial Surgery Institute of Craniofacial Surgery Providence Hospital Southfield, Mich.