Abstract
Defects in head and neck regions are standardly treated with microvascular grafts,
such as free scapular (SFF) and fibular flaps (FFF), which are subject to a certain
amount of bone resorption over time. The aim of this study was the 3-dimensional evaluation
of bone resorption volume in both grafts. Over a period of 10 years, computed tomograms
(CT) of patients with mandibular reconstructions with SFFs and FFFs were examined.
The respective grafts were segmented as well as 3-dimensionally measured. Furthermore,
factors such as gender, age, nicotine abuse, previous disease with type 2 diabetes,
and adjuvant therapies, were examined for their influence. A total of 211 CT scans
from 67 patients (40 SFFs and 27 FFFs) were included in the study. SFFs showed slightly
higher median bone volumes (87.60% at 730 days and 86.55% at 1500 days) than FFFs
(84.40% at 730 days and 82.10% at 1500 days). When final volumes were considered,
FFFs had higher mean volume values (88.22%) than SFFs (83.82%), with significant correlation
between resorption volume and time progression (r = 0.357, p = 0.024). All previously mentioned factors had no significant effect on
bone resorption. Bone volumes of FFFs showed postoperative volume reductions similar
to those of SFFs, with isolated SFFs having markedly lower volume values. The choice
of a microvascular graft for reconstruction in the mandible proves difficult regarding
bone resorption. The presented results may support decisions about future transplantations.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to British Journal of Oral and Maxillofacial SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Current options in head and neck reconstruction.Plast Reconstr Surg. 2006; 118: 122e-133e
- Microvascular free flaps: a major advance in head and neck reconstruction.Acta Otolaryngol. 2002; 122: 779-784
- Mandibular reconstruction using microvascular free flaps: a statistical analysis of 178 cases.Plast Reconstr Surg. 2001; 108: 1555-1563
- Mandibular reconstruction in adults: a review.Int J Oral Maxillofac Surg. 2008; 37: 597-605
- Choice of osseous and osteocutaneous flaps for mandibular reconstruction.Int J Clin Oncol. 2005; 10: 234-242
- Long-term evaluation after mandibular reconstruction with fibular grafts versus microsurgical fibular flaps.J Oral Maxillofac Surg. 2007; 65: 281-286
- A comparison of bone resorption over time: an analysis of the free scapular, iliac crest, and fibular microvascular flaps in mandibular reconstruction.J Oral Maxillofac Surg. 2017; 75: 616-621
- The free iliac crest and fibula flaps in vascularized oromandibular reconstruction: comparison and long-term evaluation.Head Neck. 1999; 21: 639-647
- The effect of cigarette smoking on the survival of free vascularized and pedicled epigastric flaps in the rat.Plast Reconstr Surg. 1996; 97: 86-96
- Acute alcohol withdrawal and free flap mandibular reconstruction outcomes.Arch Facial Plast Surg. 2001; 3: 264-266
- Atrophy of free fibular grafts after mandibular reconstruction.Plast Reconstr Surg. 2007; 119: 151-156
- Long-term evaluation of bone mass in free fibula flap mandible reconstruction.Am J Surg. 1997; 174: 503-506
- Evaluation of bone resorption in fibula and deep circumflex iliac artery flaps following dental implantation: a three-year follow-up study.J Craniomaxillofac Surg. 2017; 45: 474-478
- Early bone resorption of free microvascular reanastomized bone grafts for mandibular reconstruction–a comparison of iliac crest and fibula grafts.J Craniomaxillofac Surg. 2014; 42: e217-e223
- Evaluation of bone height in osseous free flap mandible reconstruction: an indirect measure of bone mass.Plast Reconstr Surg. 1999; 103: 1371-1377
- Evaluation of bone height of the free fibula flap in mandible reconstruction.J Craniofac Surg. 2015; 26: 673-676
- Twelve-year experience in mandibular reconstruction using osteo-muscular dorsal scapular pedicled flaps.J Plast Reconstr Aesthet Surg. 2021; 74: 259-267
- Cortical bone resorption of fibular bone after maxillary reconstruction with a vascularized fibula free flap: a computed tomography imaging study.Int J Oral Maxillofac Surg. 2019; 48: 1009-1014
- Bone volume change following vascularized free bone flap reconstruction of the mandible.J Craniomaxillofac Surg. 2020; 48: 859-867
- Osseous changes over time in free fibular flap reconstruction.Laryngoscope. 2019; 129: 1113-1116
- Union and bone resorption of free fibular flaps in mandibular reconstruction.J Reconstr Microsurg. 2013; 29: 427-432
- Plating in microvascular reconstruction of the mandible: can fixation be too rigid?.J Craniofac Surg. 2009; 20: 1451-1454
- Long-term changes in bone height after mandibular reconstruction using a free fibula graft in an elderly population.J Oral Maxillofac Surg. 2017; 75: 2682-2688
- Resorption of fibula bone following mandibular reconstruction for osteoradionecrosis.Br J Oral Maxillofac Surg. 2014; 52: 375-378
- Long-term results of partial double-barrel vascularized fibula graft in symphysis for extensive mandibular reconstruction.J Oral Maxillofac Surg. 2012; 70: 983-991
- Prosthetic design related to peri-implant bone resorption in microvascular free fibular flap among patients with oral cancer: a retrospective clinical study.J Prosthet Dent. 2020; 124: 395-399
- Implants in free fibula flap supporting dental rehabilitation - implant and peri-implant related outcomes of a randomized clinical trial.J Craniomaxillofac Surg. 2016; 44: 1849-1858
- Scapular free flap as a good choice for mandibular reconstruction: 119 out of 280 cases after resection of oral squamous cell carcinoma in a single institution.Br J Oral Maxillofac Surg. 2020; 58: 451-457
- Donor site morbidity after scapular tip free flaps in head-and-neck reconstruction.Microsurgery. 2015; 35: 447-450
- VIDEO: Preoperative CT angiography for scapula osteocutaneous free flap reconstructions.AJR Am J Roentgenol. 2019; 213: W143-W144
Article info
Publication history
Published online: August 22, 2022
Accepted:
August 17,
2022
Received in revised form:
May 16,
2022
Received:
January 7,
2022
Identification
Copyright
© 2022 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
