Non-vascularized Iliac Bone Graft Research Articles

A modified induced membrane 2-stage technique using a thoracodorsal artery perforator free flap followed by vascularized or non-vascularized free fibular transfer for the treatment of complex bone infection with concomitant severe soft tissue lesion–A case series of 9 cases

Treatment of post-traumatic complex bone infection is very challenging. The two principal bone reconstruction approaches are the single-stage vascularized bone graft technique and the two-stage induced membrane technique (IMT). Here we introduce a modified 2-stage induced membrane technique (MIMT) for complex long bone infection with a major bone defect and a concomitant severe soft tissue lesion. The 2-stage procedure consists of bone debridement, placement of a PMMA spacer and soft tissue reconstruction with a thoracodorsal artery perforator free flap (“Tdap”) at stage 1. At stage 2, the thoracodorsal artery perforator flap is elevated and a fibular strut graft (either vascularized of non-vascularized) is placed for bone reconstruction.We retrospectively analyzed the extents of lower extremity, long bone, post-traumatic bone infection treated via MIMT from 2008 to 2020. There were nine such cases (eight males) of mean age 59.8 (range 31 to 79) years. The osteomyelitis durations ranged from 3 to 360 months (mean 53 months). The cortical bone defect sizes was ranged from 9 to 14 cm (mean10.7 cm). All skin resurfacing employed Tdap. Vascularized fibular grafts were placed in six patients and non-vascularized grafts were placed in three. The fibular graft size ranged from 12.5 to 19 cm (mean 16.2 cm). Non-vascularized iliac bone grafts served as the fibula docking sites.Unfortunately, all patients suffered complications before bone union was achieved. One case of plate stress fracture and one case of screw fracture required plate and screw change. In three cases of cellulitis, one resolved by use of intravenous antibiotics, others required plate and screw removal. Wound disruption required re-suture and distal skin flap partial necrosis was covered by perforator-based island flap. One case of fibular stress fracture needed cast for 4 weeks. A peroneal nerve palsy patient recovered spontaneously. Bone union was achieved after 6 months in five patients and after 8 months in three (mean 6.9 months). All patients were able to walk unaided. The follow-up period ranged from 2 to 14 years (mean 6.2 years).MIMT saves the limbs in cases with difficult post-traumatic bone infection. It is valid treatment option for complex bone infections with severe soft tissue lesions. However, even with this technique potential complication must be considered.

Outcome of Mandibular Reconstruction Using Non-Vascularized Block Iliac Bone Graft

Outcome of Mandibular Reconstruction Using Non-Vascularized Block Iliac Bone Graft

Assessment the results of using nonvascularized iliac bone graft for early reconstruction of traumatic orbital floor fractures

Assessment the results of using nonvascularized iliac bone graft for early reconstruction of traumatic orbital floor fractures

Nonvascularized Iliac Bone Reconstruction for the Mandible Without Maxillofacial Skin Scarring

There are many methods to reconstruct the mandible, but they are often accompanied by trauma, which can lead to scarring of the maxillofacial skin. The purpose of this study was to show the utility of a minimally invasive method for reconstruction of the mandible with nonvascularized iliac bone grafts without a skin scar, as well as to evaluate the success rate and complications. This was a retrospective case series. We retrospectively analyzed patients who underwent transoral resection of benign mandibular pathologies, followed by nonvascularized iliac bone graft reconstruction. The primary outcome variable was the success rate of the bone grafts. Secondary outcome variables were postoperative complications at the grafted bone recipient and donor sites, the long-term absorptivity of grafted bone, and the type of mandibular defect. We computed descriptive statistics or performed the χ2 test for each variable. Overall, 54 patients were included in the study, including 21 male and 33 female patients, with an age range of 10 to 65years. The complete survival rate was 87.0% (47 of 54 patients), and the partial survival rate was 98.1% (53 of 54).The average bone absorption rate 3years after surgery was 1.8 to 30.7%. We propose a new classification method for mandibular defects based on the extent of the tumor, location of the osteotomy, and degree of surgical difficulty. Intraoral nonvascularized iliac bone grafting is a highly successful minimally invasive method for mandibular reconstruction. It is also one of the best methods for mandibular reconstruction in patients with benign mandibular tumors without soft tissue involvement.

The use of autogenous free vascularized fibula transplant for the correction of severe mandibular atrophy

The purpose of the study was to increase the effectiveness of surgical treatment and rehabilitation of patients with severe mandibular atrophy by means of autogenous free vascularized fibula transplant use with subsequent dental implants placement in the reconstructed mandible and implant-retained fixed dentures. In 2017 5 female patients underwent surgical treatment of severe mandibular atrophy with autogenous free vascularized fibula transplant in Maxillofacial Surgery department of CRID with additional nonvascularized iliac bone grafts and functional rehabilitation with implant-supported constructions in two of the cases. Due to its form, length and vascularization fibular bone represents a good plastic material for full length mandibular alveolar part reconstruction. The inclusion of the skin paddle in the autogenous free vascularized fibula transplant promotes secure primary closure of the surgical wound in the oral cavity. The use autogenous free vascularized fibula transplant in patients with severe mandibular atrophy with demands a thorough presurgical planning and intraoperative modeling.

Thumb reconstruction using wrap-around flap from the big toe, dorsalis pedis flap and iliac crest bone graft: a report of 5 cases

Objective To explore the surgical techniques and clinical outcomes of combined transfer of big toe wrap-around flap and dorsalis pedis flap with iliac bone graft for reconstruction of the whole thumb. Methods Five patients with complete thumb defect underwent combined transfer of the wrap-around flap from the big toe and the dorsalis pedis flap. The bone defect was repaired by non-vascularized iliac bone graft. Results Primary wound healing was achieved in all the patients. The reconstructed thumbs all survived uneventfully. Partial necrosis of the skin graft at the big toe donor site occurred in one case which was healed after dressing change. X-ray examination 8 to 12 weeks after the surgery revealed bone union between the grafted bone and the remaining thumb phalanx, when the internal fixation was removed. The patients were follow-up for 8 to 38 months. The appearance of the reconstructed thumb was comparable to a normal one. The thumbs had good perfusion and proper nail growth. Sensory recovery reached S2 to S3 on the dorsum of the thumb and S2 to S4 on the pulp. No motion was observed in 2 cases with metacarpophalangeal joint fusion. Opposition with the fingers and palmar opposition could be accomplished in all 5 cases. Nonunion and resorption of the grafted bone did not occur. According to the functional evaluation criteria for thumb and finger reconstruction issued by the Chinese Medical Association, the results were excellent in 4 cases and good in 1 case. Skin graft at the donor sites healed well without ulceration or scar contracture. Walking was not impaired. Linear scar occurred in the iliac donor sites without discomfort. The patients were satisfied with the results. Conclusion Combined transfer of big toe wrap-around flap and dorsalis pedis flap with iliac bone graft is an ideal procedure for reconstruction of the whole thumb. It restores the proper appearance of the thumb without sacrificing any toes. Key words: Thumbs; Surgical flaps; Defects; Grafted bone

Mandibular Nonvascularized Bone Grafts of Critical Sizes and Complex Warfare Defects With Interrami Intraoral Fixation.

The reconstruction of mandibular bone grafts of critical size complex defects and posterior segments malpositioned due to modern warfare injuries is a difficult, challenging task. The condition becomes even more complex if primary reconstruction is carried out inexpertly, which leads to severe disfigurement, rami mesial superior shift, tongue prolapsed, loss of speech, etc.A new interrami intraoral Kirschner wire fixation (IRIF) technique is presented for the reconstruction of large mandibular defects by nonvascularized iliac bone grafts. Twelve symphysis, parasymphysis, and lateral mandibular avulsed or chopped off with bone loss ranging from 5 cm to "ear-to-ear" rami defects underwent nonvascularized iliac bone block graft. A direct stainless steel wire fixation was carried out between bone blocks and original bone. Indirect rigid fixations were applied using a 2-mm horseshoe-shaped K-wire IRIF technique. Two complications were reported: one due to infection and the other due to the mucosa dehiscing where 2 cm of sequestrated bone was removed. The biomechanics (stress/strain distribution and strength) along the K-wire substitute the tension on the alveolar part of the mandible, creating a zone of resistance in the rami zone. This successful bone healing between the mandibular bone and the graft may have resulted from prolonged periods of sufficient stabilization during function of the mandible and bone graft function as one mandible unit during the healing period by IRIF. This new technique is quick, cheap, easy, and well tolerated by the patient for many months without complications and has been successful in modern warfare reconstructions of mandibular bone graft large defects.

The Success Rate of Implants Placed in Reconstructed Alveolar Ridges Using Iliac Bone Graft Compared to Non-augmented Jaw

Aim: This study is aimed to investigate the success rate and clinical outcome of placed implants in reconstructed alveolar ridges using iliac cortico-cancellus bone graft compared to normal nonaugmented alveolar ridge. Materials and Methods: In this clinical trial study, 30 patients who were selected and assigned in case and control groups. The case group included patients with severe alveolar bone loss, who needed bone grafting. The control group included patients with sufficient alveolar ridge and no Original Research Article Attar et al.; BJMMR, 9(2): 1-7, 2015; Article no.BJMMR.18216 2 need for bone grafting. The prosthesis was placed on implants after 3 to 8 months. Plaque index, bleeding, pocket depth, mobility, pain, pus secretion and bone loss were evaluated after 24 month. Data were analyzed by SPSS 13. P-value less than 0.05 was considered as significant. Results: Out of 30 patients, two were excluded due to their requirements. Totally 97 implants were placed in patients, which included 52 implants in control group and 45 implants in case group. All of the implants were successfully osseointegrated and loaded. There was no significant difference between the success of inserted implants between both groups (P=0.05). The mesial and distal bone losses were significantly more in patients without iliac bone graft (P=0.05). There was no statistically significant difference between measured outcomes including plaque, bleeding, pocket depth, mobility, pain, and pus secretion (P=0.05). Conclusion: Inserted implant in free non-vascularized iliac bone graft has high rate of success comapred to non-augmented alveolar ridges and has shown to be a reliable method for reconstruction of severe atrophic jaws.

Ilial crest bone graft transposition as treatment for fracture of the medial femoral trochlear ridge in a dog

This is a report of a fracture of the medial trochlear ridge of the distal femur occurring as a major complication after surgery for medial patellar luxation. To address the complication, a non-vascularized iliac bone graft was collected and fixated with two positional screws to the trochlea. An external skeletal fixator was placed to prevent motion of the stifle joint during the healing period and to reduce the risk for fragment dislodgment. One year after the graft was placed the dog's function was satisfactory. This case report indicates that a non-vascularized iliac bone graft provides an alternative for management of fractures of the medial ridge of the distal femur.

Non-vascularized bone graft with Herbert-type screw fixation for proximal pole scaphoid nonunion

BackgroundSince proximal pole fractures of the scaphoid are frequently overlooked, the poor vascularity in the proximal pole fragment often leads to nonunion. Vascularized bone grafts have been recently tested in cases with scaphoid proximal pole nonunion, but the indication for this treatment has not been well established. Alternatively, we have been treating such patients with a non-vascularized iliac bone graft and Herbert-type screw fixation with considerable success. The purpose of this investigation is to evaluate these cases retrospectively and clarify the surgical efficacy of our procedure. MethodsBetween 1996 and 2009, 11 consecutive patients with proximal pole scaphoid nonunion were treated with a non-vascularized corticocancellous iliac bone graft and Herbert-type screw fixation. They were all male aged from 12 to 26 years. In two patients, avascular changes were recognized in the proximal pole in preoperative radiographs or MRI. Follow-up ranged from 12 to 76 months. ResultsBone union was radiographically confirmed in all patients, who returned to their former activities without any complications. The period from operation to union ranged from 12 to 24 weeks. The mean Mayo modified wrist score was 76.4 points preoperatively and 91.4 points postoperatively, and was improved in all cases. ConclusionsA non-vascularized iliac bone graft with Herbert-type screw fixation obtained satisfactory clinical and radiographic results in cases with scaphoid proximal pole nonunion, regardless of the vascularity in the proximal fragment.

Comparison of Donor Site Engraftment After Harvesting Vascularized (V) and Non-Vascularized (NV) Iliac Bone Grafts

Comparison of Donor Site Engraftment After Harvesting Vascularized (V) and Non-Vascularized (NV) Iliac Bone Grafts

Comparison of Donor-Site Engraftment After Harvesting Vascularized and Nonvascularized Iliac Bone Grafts

The objective of this study is to characterize the donor-site morbidity after harvesting of nonvascularized and vascularized iliac bone grafts. Clinical data of 353 patients were collected for analysis. In addition, a questionnaire was sent to all patients asking about their perceptions of different parameters. In an individual age-matched layout, we compared 34 patients with nonvascularized iliac bone grafts with 34 patients with vascularized iliac bone grafts. Transplantation of vascularized bone grafts has been increasingly performed at our institution. The mean age was 41.5 years in the nonvascularized group and 48.6 years in the vascularized group. The main reason for the bony defect in the vascularized group was malignancy. The majority of postoperative functional problems were observed in obese patients. No patient had serious or long-term complications at the donor site. The amount of bone graft taken affected postoperative sensitivity disturbance and caused postoperative functional problems and pain. We conclude that the iliac crest is a suitable site for harvesting both vascularized and nonvascularized bone grafts measuring up to 10 x 3 cm. For larger defects that require a larger bone graft, a vascularized bone graft is more suitable with a better predictable healing capability. No significant differences in donor-site morbidity were found between the vascularized and nonvascularized bone grafts if a similar amount of bone was taken for transplant.

Reconstruction of Mandibular Defects Using Autografts Combined With Demineralized Bone Matrix and Cancellous Allograft

Facial bone defects can be managed by a variety of means, such as inlay or onlay applied nonvascularized bone grafts, local pedicled/distal free osteocutaneous/osseous flaps or distraction osteogenesis. Although each method has its own advantages and drawbacks, the indications of using these methods may overlap in certain clinical situations. The use of nonvascularized bone grafts, conceptually and technically simple method, relies on creeping substitution of applied graft with regenerating new bone. However, using vascularized osteocutaneous free flaps provide not only plenty of bony tissue for reconstruction, but also soft tissue coverage over the reconstructed bony segment. Furthermore, bone healing in vascularized osteocutaneous free flaps resembles as the physiologic fracture healing. In selected cases with enough soft tissue coverage over the defective bony segment, on the other hand, using larger nonvascularized bone grafts with osteoinductive growth factors may decrease the risk of graft failure while avoiding the drawbacks of the free tissue transfer. Here we present our results of three cases with facial bone defects, to which nonvascularized iliac bone grafts and demineralized bone matrix with cancellous allograft (Orthoblast II) as a source of BMP were used together for mandibular reconstruction.