Bone graft scintigraphy. A new diagnostic tool to assess perfusion during surgery

To evaluate a scintigraphic tool for intraoperative assessment of vascularized bone graft perfusion before and after transplantation.

This pilot study included three patients scheduled for surgical segmental mandibulectomy followed by reconstruction with a vascularized iliac bone graft. A continuous (99m)Tc-pertechnetate infusion was applied selectively arterial into the blood vessel supplying the respective graft before osteotomy as well as after transplantation. Perfusion was analysed by scintigrams acquired using the intraoperative camera systems declipseSPECT and Sentinella. Results were compared qualitatively.

Before harvesting the graft, intraoperative scintigraphy revealed a clearly delineated area of the iliac crest with a relatively homogenous pertechnetate distribution representing good perfusion. After osteotomy, transplantation to the mandibula and re-anastomosis of the nutrient vessels, scintigraphy in all patients showed a moderately inhomogenous distribution pattern of the pertechnetate indicating an adequate perfusion of the bone transplant through the arterial anastomosis.

Intraoperative assessment of bone graft perfusion is possible with the imaging systems Sentinella as well as with declipseSPECT using a continuous intra-arterial infusion of 99mTc-pertechnetate.