[Evaluation of the usefulness of vascularized bone grafts for surgical reconstruction of the face]

The process of healing of vascularised bone grafts was examined clinically and the use of vascularised bone grafts in face reconstruction surgery was assessed basing on author's experience with the surgical technique, availability of graft recipient and donor sites and final outcome. Patients enrolled in this study were treated at the Department of Maxillofacial Surgery, Pomeranian Academy of Medicine in Szczecin, for cancer, injuries, developmental anomalies and atrophic changes. In each case it was necessary to restore facial bone structures of functional and aesthetic importance, including: floor of the orbital cavity, alveolar process of maxilla, palate, malar bone and mandible (Tab. 2). Reconstruction was done mostly with parietal bone grafts pedicled on temporal fascia and muscle, coronoid process of the mandible pedicled on temporal muscle, and lower part of the diaphysis of mandible pedicled on masseter and pterygoid muscles. In some cases, reconstruction material consisted of a rib on greater pectoral muscle, clavicle on sternocleidomastoid muscle and scapular bone crest pedicled on trapezius muscle. Free microvascular flaps with some elements of fibula and radius were used in two patients for the reconstruction of mandible and soft tissues. In total, 41 vascularised grafts were performed in 40 patients. Graft healing was examined clinically and usefulness of this technique for face reconstruction surgery was assessed basing on author's experience with the preparation technique, intraoperative complications and extent of trauma to donor sites. The results of healing of specific grafts are enclosed in Table 1. The surgical technique for graft preparation and its transfer into the recipient site varied from case to case. The most difficult and effortful approach was with free bone grafts transferred from remote sites by means of a microsurgical technique (group V). Despite the complexity of the reconstruction method, no intraoperative complications occurred in the course of preparation of the radial and fibular bone grafts. In group IV, the most difficult grafts included those taken from ribs, clavicle and scapular bone. Parietal bone grafts were much less troublesome (subgroups Ia and Ib) although associated with the largest number of intraoperative complications. The easiest preparation method applied to the grafting of coronoid process and lower part of the body of mandible (group II and III). Clinical evaluation of vascularised bone grafts confirmed without reservations the value of this approach in face reconstruction surgery. However, the extent to which individual graft types proved to be usable varied. The most valuable ones included parietal bone grafts pedicled on temporal muscle and fascia used for restoring upper and central facial structures and the coronoid process of mandible pedicled on temporal muscle used for reconstructing the floor of the orbital cavity and alveolar process of the maxilla. Rib grafts pedicled on pectoral muscle were of limited use. The same applies to grafts from the lower part of the body of mandible pedicled on masseter and pterygoid muscles occasionally used for restoring the mental part of mandible. Grafts from remote sites (fibula, radius) should be used only when other reconstruction methods are unavailable.