0
August 1991, Vol 117, No. 8 >
ARTICLE | August 1991

Mandible Reconstruction With Vascularized Bone Grafts: Title and subTitle BreakA Histologic Evaluation FREE

Henry T. Hoffman, MD; Nancy Harrison, MD; Michael J. Sullivan, MD; K. Thomas Robbins, MD; Marion Ridley, MD; Shan R. Baker, MD
[+] Author Affiliations

Accepted for publication provisionally November 26, 1990; final acceptance after revision March 5, 1991.

Reprint requests to Department of Otolaryngology—Head and Neck Surgery, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242 (Dr Hoffman).


Arch Otolaryngol Head Neck Surg. 1991;117(8):917-925. doi:10.1001/archotol.1991.01870200111020
Text Size: A A A
Published online
Article
References
Comments

• To our knowledge, a histologic evaluation of bone healing after mandible reconstruction with vascularized human bone grafts has not been previously reported. Serial sections through both the decalcified graft and the junction between mandible and graft were evaluated in four patients who required surgical removal of their reconstructed mandibles. A failed scapular bone graft that had been wrapped within a pectoralis major myocutaneous flap for salvage following pedicle thrombosis showed markedly resorbed but viable bone with a fibrous union to the native mandible. Viable vascularized grafts without evidence of ongoing resorption characterized an iliac osteocutaneous bone graft and two scapula osteocutaneous grafts that healed with continuity of healthy bone between graft and mandible. Observations from the evaluation of these specimens are made regarding bone circulation, bone union, and bone graft survival as they occur clinically. Implications regarding the techniques of bone plating and indications for use of vascularized bone in mandible reconstruction are discussed.

(Arch Otolaryngol Head Neck Surg. 1991;117:917-925)

REFERENCES

1 +
Pearl RM, LePore V, Hentz VR, Sarig A.  An approach to mandibular reconstruction . Ann Plast Surg. 1988;;21:402-417.
2 +
Lambert PM and Patel M.  Hemandibulectomy without bone grafting: report of a case . Head Neck Surg. 1986;;8:375-378.
3 +
Komisar A.  The functional result of mandibular reconstruction . Laryngoscope . 1990;;100:364-374.
4 +
Panje WR.  Immediate reconstruction of the oral cavity . In: Thawley SE, Panje WR, eds. Comprehensive Management of Head and Neck Tumors . Philadelphia, Pa: WB Saunders Co; 1987;:563-593.
5 +
Gullane PJ, Holmes H.  Mandibular reconstruction: new concepts . Arch Otolaryngol Head Neck Surg. 1986;;112:714-719.
6 +
Tucker HM.  Nonrigid reconstruction of the mandible . Arch Otolaryngol Head Neck Surg. 1989;;115:1190-1192.
7 +
Lind MG, Cmander C, Gylbert L, Heden P, Jurell G.  Reconstruction in the head and neck regions with free radial forearm flaps and split-rib bone grafts . Am J Surg. 1987;;154:459-462.
8 +
LaFerriere KA, Sessions DG, Thawley SE, Wood BG, Ogura JH.  Composite resection and reconstruction for oral cavity and oropharynx cancer: a functional approach . Arch Otolaryngol Head Neck Surg. 1980;;106:103-110.
9 +
Murphy JB, Weisman RA, Kent K.  The use of stabilization plates in the immediate repair of defects following mandibular resection . Oral Surg Oral Med Oral Pathol. 1989;;68:380-384.
10 +
Soderholm AL, Lindquist C, Laine P, Kontio R.  Primary reconstruction of the mandible in cancer surgery . Int J Oral Maxillofac Surg. 1988;;17:194-197.
11 +
Gluckman JL.  Mandibular reconstruction . Ear Nose Throat J. 1986;;65:522-527.
12 +
Wenig BL, Keller AJ, Stern JR, et al.  Anatomic reconstruction and functional rehabilitation of oromandibular defects with rigid internal fixation . Laryngoscope . 1988;;98:154-159.
13 +
Papel ID, Price JC, Kashima HK, Johns ME.  Compression plates in the treatment of advanced anterior floor of mouth carcinoma . Laryngoscope . 1986;;96:722-725.
14 +
Leung PC, Chow SK, Ma GFY.  Primary reconstruction of the mandible after excision of large benign lesions . Br J Plast Surg. 1988;;41:251-254.
15 +
Schwartz HC, Leake DL, Pizzoferato A.  Evaluation of autologous cancellous bone grafting of mandibular discontinuity defects in dogs using a Dacron-urethane prosthesis . J Oral Maxillofac Surg. 1987;;45:143-148.
16 +
Lawson W, Baek S, Loscalzo L, Biller H, Krespi Y.  Experience with immediate and delayed mandibular reconstruction . Laryngoscope . 1982;;92:5-10.
17 +
Klotch DW, Prein J.  Mandibular reconstruction using AO plates . Am J Surg. 1987;;154:384-387.
18 +
Wenig BL, Keller AJ.  Rigid internal fixation and vascularized bone grafting in mandibular reconstruction . Clin Plast Surg. 1989;;16:125-131.
19 +
Salibian AH, Rappaport I, Allison G.  Functional oromandibular reconstruction with the microvascular composite groin flap . Plast Reconstr Surg. 1985;;76:819-828.
20 +
Duncan MJ, Manktelow RT, Zuker RM, Rosen IB.  Mandibular reconstruction in the radiated patient: the role of osteocutaneous free tissue transfers . Plast Reconstr Surg. 1985;;76:829-840.
21 +
David DJ, Tan E, Katsaros J, Sheen R.  Mandibular reconstruction with vascularized iliac crest: a 10-year experience . Plast Reconstr Surg. 1988;;82:792-801.
22 +
Stefani G, Guizzi P, Battiston B, Brunelli G.  Research on the biology of microvascular bone grafts . In: Aebi M, Regazzoni P, eds. Bone Transplantation . New York, NY: Springer-Verlag NY Inc; 1989;.
23 +
Fig LM, Shulkin BL, Sullivan MJ, Rubinstein MI, Baker SR.  Utility of emission tomography in evaluation of mandibular bone grafts . Arch Otolaryngol Head Neck Surg. 1990;;116:191-196.
24 +
Berggren A, Weiland AJ, Ostrup LT, Dorfman H.  Microvascular free bone transfer with revascularization or the medullary and periosteal circulation of the periosteal circulation alone . J Bone Joint Surg Am. 1982;;64:73-87.
25 +
Berggren A, Weiland AJ, Dorfman H.  Free vascularized bone grafts: factors affecting their survival and ability to heal to recipient bone defects . Plast Reconstr Surg. 1982;;69:19-29.
26 +
Morales MJ, Marx RE, Gottleib CF.  Effects of pre- and postoperative irradiation on the healing of bone grafts in the rabbit . J Oral Maxillofac Surg. 1987;;45:34-41.
27 +
Canalis RF, Saffouri M, Mirra J, Ward PH.  The fate of pedicle osteocutaneous grafts in mandibulo-facial restoration . Laryngoscope . 1977;;87:895-908.
28 +
Burchardt H.  The biology of bone graft repair . Clin Orthop. 1983;;174:28-42.
29 +
Weiland AJ.  Fate of vascularized bone grafts . In: Aebi M, Regazzoni P, eds. Bone Transplantation . New York, NY: Springer-Verlag NY Inc; 1989;.
30 +
Phemister DB.  The fate of transplanted bone and regenerative power of various constituents . SGO . 1914;;19:303-333.
31 +
Burchardt H.  The biology of bone graft repair . Clin Orthop. 1983;;174:28-42.
32 +
Puranen J.  Reorganization of fresh or preserved bone transplants: experimental study in rabbits using tetracycline labeling . Acta Orthop Scand (Suppl) . 1966;;92:9-75.
33 +
Enneking WF, Burchardt H, Puhl JJ, Piotrowski G.  Physical and biological aspects of repair in dog cortical bone transplants . J Bone Joint Surg Am. 1975;;57:237-252.
34 +
Bogumill GP, Schwann HA. Orthopaedic Pathology: A Synopsis With Clinical and Radiographic Correlation . Philadelphia, Pa: WB Saunders Co; 1984;:70-86, 163-173.
35 +
Weissman B.  Imaging following bone surgery . In: Resnik D, Niwayama G, eds. Diagnosis of Bone and Joint Disorders . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1988;:536-541.
36 +
Burchardt H.  Biology of cortical bone graft incorporation . In: Aebi M, Regazzoni P, eds. Bone Transplantations . New York, NY: Springer-Verlag NY Inc; 1989;:9923-9928.
37 +
Berggren A, Weiland AJ, Dorfman H.  The effect of prolonged ischemia time on osteocyte and osteoblast survival in composite bone grafts revascularized by microvascular anastomoses . Plast Reconstr Surg. 1982;;69:290-298.
38 +
Haas SL.  A study of the viability of bone after removal from the body . Arch Surg. 1923;;7:213-226.
39 +
Weiland AJ, Phillips TW, Randolph MA.  Bone grafts: a radiologic, histologic and biomechanical model comparing autografts, allografts, and free vascularized bone grafts . Plast Reconstr Surg. 1984;;74:368-379.
40 +
Ostrup LT, Fredrickson JM.  Reconstruction of mandibular defects after radiation using a free, living bone graft transferred by microvascular anastomoses: an experimental study . Plast Reconstr Surg. 1975;;55:563-571.
41 +
Cutting CB, McCarthy JG.  Comparison of residual osseous mass between vascularized and nonvascularized only bone transfers . Plast Reconstr Surg. 1983;;72:672-675.
42 +
deFries HO, Marble H, Sell KW.  Reconstruction of the mandible . Arch Otolaryngol. 1971;;93:426-432.
43 +
Ostrup LT, Fredrickson J.  Reconstruction of mandibular defect after irradiation using a free living bone graft transferred by microvascular anastomosis . Plast Reconstr Surg. 1975;;55:563.
44 +
Hayashi S, Suit HD.  The effect of fractionation of radiation dose on callus formation at site of fracture . Radiology . 1971;;101:181-186.
45 +
Pelker RR, Friedlaender GE, Panjabi MM, Kapp D, Doganis A.  Radiation-induced alteration of fracture healing biomechanics . J Orthop Res. 1984;;2:90-96.
46 +
Jacobsson M, Jonsson A, Albrektsson T, Turesson I.  Dose-response for bone regeneration after single doses of 60Co irradiation . Int J Radiat Oncol Biol Phys. 1985;;11:1963-1969.
47 +
Jacobbson MG, Jonsson AK, Albrektsson TO, Turesson IE.  Short- and long-term effects of irradiation on bone regeneration . Plast Reconstr Surg. 1985;;76:841-850.
48 +
Bosse JP, Teot L, Banis J, Drzewiecki A.  The scapular osteocutaneous flap . In: Brunelli, G. Textbook of Microsurgery . New York, NY: Masson Publishers USA Inc; 1988;:269-281.
49 +
Swartz WM, Banis JC, Newton ED, Ramasastry SS, Jones NJ, Acland R.  The osteocutaneous scapular flap for mandibular and maxillary reconstruction . Plast Reconstr Surg. 1986;;77:530-545.
50 +
Catto MA.  A histological study of avascular necrosis of the femoral head after transcervical fracture . J Bone Joint Surg Br. 1965;;47:749-776.
51 +
Cormack DH. Ham's Histology . 9th ed. Philadelphia, Pa: JB Lippincott; 1987;:273-321.
52 +
Gonzalez del Pino J, Knapp K, Castresana FG, et al.  Vascular medullary patency in free vascularized bone grafts: CT scan experimental study . J Reconstr Microsurg. 1988;;4:271-275.
53 +
Komisar A, Warman S, Danziger E.  A critical analysis of immediate and delayed mandibular reconstruction using A-0 plates . Arch Otolaryngol Head Neck Surg. 1989;;115:830-833.
54 +
Kruger E, Krumholtz K.  Results of bone grafting after rigid fixation . J Oral Maxillofac Surg. 1984;;42:491-496.
55 +
Kennady MC, Tucker MR, Lester GE, Buckley MJ.  The stress shielding effect of rigid internal fixation plates on mandibular bone grafts: a photon absorption densitometry and quantitative computerized tomographic evaluation . Int J Oral Maxillofac Surg. 1989;;18:307-310.
56 +
Gartland JJ. Fundamentals of Orthopaedics . 3rd ed. Philadelphia, Pa: WB Saunders Co; 1979;:6-7.
57 +
Buchbinder D, Urken ML, Vickery C, Weinberg H, Sheiner A, Biller H.  Functional mandibular reconstruction of patients with oral cancer . Oral Surg Oral Med Oral Pathol. 1989;;68:499-504.
58 +
Taylor GI, Miller DGH, Ham FJ.  The free vascularized bone graft . Plast Reconstr Surg. 1975;;55:533-544.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Pearl RM, LePore V, Hentz VR, Sarig A.  An approach to mandibular reconstruction . Ann Plast Surg. 1988;;21:402-417.
2 +
Lambert PM and Patel M.  Hemandibulectomy without bone grafting: report of a case . Head Neck Surg. 1986;;8:375-378.
3 +
Komisar A.  The functional result of mandibular reconstruction . Laryngoscope . 1990;;100:364-374.
4 +
Panje WR.  Immediate reconstruction of the oral cavity . In: Thawley SE, Panje WR, eds. Comprehensive Management of Head and Neck Tumors . Philadelphia, Pa: WB Saunders Co; 1987;:563-593.
5 +
Gullane PJ, Holmes H.  Mandibular reconstruction: new concepts . Arch Otolaryngol Head Neck Surg. 1986;;112:714-719.
6 +
Tucker HM.  Nonrigid reconstruction of the mandible . Arch Otolaryngol Head Neck Surg. 1989;;115:1190-1192.
7 +
Lind MG, Cmander C, Gylbert L, Heden P, Jurell G.  Reconstruction in the head and neck regions with free radial forearm flaps and split-rib bone grafts . Am J Surg. 1987;;154:459-462.
8 +
LaFerriere KA, Sessions DG, Thawley SE, Wood BG, Ogura JH.  Composite resection and reconstruction for oral cavity and oropharynx cancer: a functional approach . Arch Otolaryngol Head Neck Surg. 1980;;106:103-110.
9 +
Murphy JB, Weisman RA, Kent K.  The use of stabilization plates in the immediate repair of defects following mandibular resection . Oral Surg Oral Med Oral Pathol. 1989;;68:380-384.
10 +
Soderholm AL, Lindquist C, Laine P, Kontio R.  Primary reconstruction of the mandible in cancer surgery . Int J Oral Maxillofac Surg. 1988;;17:194-197.
11 +
Gluckman JL.  Mandibular reconstruction . Ear Nose Throat J. 1986;;65:522-527.
12 +
Wenig BL, Keller AJ, Stern JR, et al.  Anatomic reconstruction and functional rehabilitation of oromandibular defects with rigid internal fixation . Laryngoscope . 1988;;98:154-159.
13 +
Papel ID, Price JC, Kashima HK, Johns ME.  Compression plates in the treatment of advanced anterior floor of mouth carcinoma . Laryngoscope . 1986;;96:722-725.
14 +
Leung PC, Chow SK, Ma GFY.  Primary reconstruction of the mandible after excision of large benign lesions . Br J Plast Surg. 1988;;41:251-254.
15 +
Schwartz HC, Leake DL, Pizzoferato A.  Evaluation of autologous cancellous bone grafting of mandibular discontinuity defects in dogs using a Dacron-urethane prosthesis . J Oral Maxillofac Surg. 1987;;45:143-148.
16 +
Lawson W, Baek S, Loscalzo L, Biller H, Krespi Y.  Experience with immediate and delayed mandibular reconstruction . Laryngoscope . 1982;;92:5-10.
17 +
Klotch DW, Prein J.  Mandibular reconstruction using AO plates . Am J Surg. 1987;;154:384-387.
18 +
Wenig BL, Keller AJ.  Rigid internal fixation and vascularized bone grafting in mandibular reconstruction . Clin Plast Surg. 1989;;16:125-131.
19 +
Salibian AH, Rappaport I, Allison G.  Functional oromandibular reconstruction with the microvascular composite groin flap . Plast Reconstr Surg. 1985;;76:819-828.
20 +
Duncan MJ, Manktelow RT, Zuker RM, Rosen IB.  Mandibular reconstruction in the radiated patient: the role of osteocutaneous free tissue transfers . Plast Reconstr Surg. 1985;;76:829-840.
21 +
David DJ, Tan E, Katsaros J, Sheen R.  Mandibular reconstruction with vascularized iliac crest: a 10-year experience . Plast Reconstr Surg. 1988;;82:792-801.
22 +
Stefani G, Guizzi P, Battiston B, Brunelli G.  Research on the biology of microvascular bone grafts . In: Aebi M, Regazzoni P, eds. Bone Transplantation . New York, NY: Springer-Verlag NY Inc; 1989;.
23 +
Fig LM, Shulkin BL, Sullivan MJ, Rubinstein MI, Baker SR.  Utility of emission tomography in evaluation of mandibular bone grafts . Arch Otolaryngol Head Neck Surg. 1990;;116:191-196.
24 +
Berggren A, Weiland AJ, Ostrup LT, Dorfman H.  Microvascular free bone transfer with revascularization or the medullary and periosteal circulation of the periosteal circulation alone . J Bone Joint Surg Am. 1982;;64:73-87.
25 +
Berggren A, Weiland AJ, Dorfman H.  Free vascularized bone grafts: factors affecting their survival and ability to heal to recipient bone defects . Plast Reconstr Surg. 1982;;69:19-29.
26 +
Morales MJ, Marx RE, Gottleib CF.  Effects of pre- and postoperative irradiation on the healing of bone grafts in the rabbit . J Oral Maxillofac Surg. 1987;;45:34-41.
27 +
Canalis RF, Saffouri M, Mirra J, Ward PH.  The fate of pedicle osteocutaneous grafts in mandibulo-facial restoration . Laryngoscope . 1977;;87:895-908.
28 +
Burchardt H.  The biology of bone graft repair . Clin Orthop. 1983;;174:28-42.
29 +
Weiland AJ.  Fate of vascularized bone grafts . In: Aebi M, Regazzoni P, eds. Bone Transplantation . New York, NY: Springer-Verlag NY Inc; 1989;.
30 +
Phemister DB.  The fate of transplanted bone and regenerative power of various constituents . SGO . 1914;;19:303-333.
31 +
Burchardt H.  The biology of bone graft repair . Clin Orthop. 1983;;174:28-42.
32 +
Puranen J.  Reorganization of fresh or preserved bone transplants: experimental study in rabbits using tetracycline labeling . Acta Orthop Scand (Suppl) . 1966;;92:9-75.
33 +
Enneking WF, Burchardt H, Puhl JJ, Piotrowski G.  Physical and biological aspects of repair in dog cortical bone transplants . J Bone Joint Surg Am. 1975;;57:237-252.
34 +
Bogumill GP, Schwann HA. Orthopaedic Pathology: A Synopsis With Clinical and Radiographic Correlation . Philadelphia, Pa: WB Saunders Co; 1984;:70-86, 163-173.
35 +
Weissman B.  Imaging following bone surgery . In: Resnik D, Niwayama G, eds. Diagnosis of Bone and Joint Disorders . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1988;:536-541.
36 +
Burchardt H.  Biology of cortical bone graft incorporation . In: Aebi M, Regazzoni P, eds. Bone Transplantations . New York, NY: Springer-Verlag NY Inc; 1989;:9923-9928.
37 +
Berggren A, Weiland AJ, Dorfman H.  The effect of prolonged ischemia time on osteocyte and osteoblast survival in composite bone grafts revascularized by microvascular anastomoses . Plast Reconstr Surg. 1982;;69:290-298.
38 +
Haas SL.  A study of the viability of bone after removal from the body . Arch Surg. 1923;;7:213-226.
39 +
Weiland AJ, Phillips TW, Randolph MA.  Bone grafts: a radiologic, histologic and biomechanical model comparing autografts, allografts, and free vascularized bone grafts . Plast Reconstr Surg. 1984;;74:368-379.
40 +
Ostrup LT, Fredrickson JM.  Reconstruction of mandibular defects after radiation using a free, living bone graft transferred by microvascular anastomoses: an experimental study . Plast Reconstr Surg. 1975;;55:563-571.
41 +
Cutting CB, McCarthy JG.  Comparison of residual osseous mass between vascularized and nonvascularized only bone transfers . Plast Reconstr Surg. 1983;;72:672-675.
42 +
deFries HO, Marble H, Sell KW.  Reconstruction of the mandible . Arch Otolaryngol. 1971;;93:426-432.
43 +
Ostrup LT, Fredrickson J.  Reconstruction of mandibular defect after irradiation using a free living bone graft transferred by microvascular anastomosis . Plast Reconstr Surg. 1975;;55:563.
44 +
Hayashi S, Suit HD.  The effect of fractionation of radiation dose on callus formation at site of fracture . Radiology . 1971;;101:181-186.
45 +
Pelker RR, Friedlaender GE, Panjabi MM, Kapp D, Doganis A.  Radiation-induced alteration of fracture healing biomechanics . J Orthop Res. 1984;;2:90-96.
46 +
Jacobsson M, Jonsson A, Albrektsson T, Turesson I.  Dose-response for bone regeneration after single doses of 60Co irradiation . Int J Radiat Oncol Biol Phys. 1985;;11:1963-1969.
47 +
Jacobbson MG, Jonsson AK, Albrektsson TO, Turesson IE.  Short- and long-term effects of irradiation on bone regeneration . Plast Reconstr Surg. 1985;;76:841-850.
48 +
Bosse JP, Teot L, Banis J, Drzewiecki A.  The scapular osteocutaneous flap . In: Brunelli, G. Textbook of Microsurgery . New York, NY: Masson Publishers USA Inc; 1988;:269-281.
49 +
Swartz WM, Banis JC, Newton ED, Ramasastry SS, Jones NJ, Acland R.  The osteocutaneous scapular flap for mandibular and maxillary reconstruction . Plast Reconstr Surg. 1986;;77:530-545.
50 +
Catto MA.  A histological study of avascular necrosis of the femoral head after transcervical fracture . J Bone Joint Surg Br. 1965;;47:749-776.
51 +
Cormack DH. Ham's Histology . 9th ed. Philadelphia, Pa: JB Lippincott; 1987;:273-321.
52 +
Gonzalez del Pino J, Knapp K, Castresana FG, et al.  Vascular medullary patency in free vascularized bone grafts: CT scan experimental study . J Reconstr Microsurg. 1988;;4:271-275.
53 +
Komisar A, Warman S, Danziger E.  A critical analysis of immediate and delayed mandibular reconstruction using A-0 plates . Arch Otolaryngol Head Neck Surg. 1989;;115:830-833.
54 +
Kruger E, Krumholtz K.  Results of bone grafting after rigid fixation . J Oral Maxillofac Surg. 1984;;42:491-496.
55 +
Kennady MC, Tucker MR, Lester GE, Buckley MJ.  The stress shielding effect of rigid internal fixation plates on mandibular bone grafts: a photon absorption densitometry and quantitative computerized tomographic evaluation . Int J Oral Maxillofac Surg. 1989;;18:307-310.
56 +
Gartland JJ. Fundamentals of Orthopaedics . 3rd ed. Philadelphia, Pa: WB Saunders Co; 1979;:6-7.
57 +
Buchbinder D, Urken ML, Vickery C, Weinberg H, Sheiner A, Biller H.  Functional mandibular reconstruction of patients with oral cancer . Oral Surg Oral Med Oral Pathol. 1989;;68:499-504.
58 +
Taylor GI, Miller DGH, Ham FJ.  The free vascularized bone graft . Plast Reconstr Surg. 1975;;55:533-544.

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