Tibia Bone Graft Harvest Technique

Abstract

Contemporary oral and maxillofacial surgeons need bone grafting techniques to satisfy patient needs in trauma, pathology, reconstructive surgery, and dental implantology. The ‘‘gold standard’’ for bony reconstruction of the jaws is the use of autogenous bone grafts. Autogenous grafts are believed to be advantageous in many ways. First, viable osteocytes can be carried to the graft site, and active bone regeneration or osteogenesis can occur [1]. Second, autogenous bone grafts act by osteoinduction when bone morphogenetic proteins stimulate bone formation [1]. Finally, autogenous bone grafts act as a scaffold for vascular ingrowth, which is known as osteoconduction [1]. Many patients simply request that their surgeon ‘‘use my own body to reconstruct me’’ rather than deal with potential problems associated with banked bone, allografts, xenografts, or alloplastic graft material. Fortunately, as surgeons, we have a wide choice of autogenous bone donor sites, including jaws, iliac crest, calvarium, and tibia. By expanding the donor sites to the free flap arena, surgeons can expand the donor sites to include the scapula, radius, and fibula. At the University of Louisville, we have favored the tibia graft harvest as our preferred donor site whenever possible. The tibia graft harvest is a technically easy procedure to perform, yields an excellent quantity of cancellous bone, and has a low complication rate [1–4]. The tibia graft is performed on skeletally mature patients who want the benefit of autogenous bone grafting without the risk and pain associated with other favorite donor sites, such as the iliac crest or calvarium. The surgeon easily can obtain 25 cc of cancellous bone, which is more than adequate for procedures such as bilateral sinus lifts and grafting fracture nonunions [4,5]. The tibia graft harvest can be performed in the office or in an outpatient setting, which can be a critical factor when patients are paying for procedures ‘‘out of pocket,’’ as is commonly seen with patients who receive dental implants [4]. Dental implants have become an area of keen interest to oral and maxillofacial surgeons. Being able to offer cost-effective autogenous bone grafting techniques that can fulfill various clinical applications clearly is an excellent service to patients. The tibia as a donor graft site in maxillofacial reconstruction first appeared in 1992, when Catone and colleagues [2] published their experience with 20 cases. Since then, numerous reports have been published and renewed interest has appeared in using the tibia for maxillofacial reconstruction [4–6]. The University of Louisville oral and maxillofacial surgery residents began using the tibia as a donor site in the mid 1990s while rotating on the orthopedic surgery service. The University of Louisville Hospital is a level-one trauma center that has an active orthopedic surgery service that routinely performs bone grafting in the primary and secondary stages of treatment. The oral and maxillofacial surgery residents were impressed with the versatility and excellent quantity of bone obtained from the tibia. The procedure was performed easily and had a low complication rate in their hands. The oral and maxillofacial surgery residents essentially brought the tibia graft harvest technique back to the oral and maxillofacial surgery service, and we have used the tibia graft harvest effectively for various clinical applications.