A COMPARISON OF VASCULARIZED AND NONVASCULARIZED BONE-GRAFTS FOR RECONSTRUCTION OF MANDIBULAR CONTINUITY DEFECTS

Purpose: This study compared vascularized and nonvascularized bone gra fts for the reconstruction of segmental defects of the mandible. Patie nts and Methods: The results in 39 patients having vascularized bone g rafts (38 fibulas and one iliac crest) and 29 patients having nonvascu larized bone grafts (26 iliac crest [22 corticocancellous block grafts , four cancellous bone grafts in a tray] and three rib grafts) for seg mental mandibular reconstruction were evaluated in terms of overall su ccess rate, total number of surgeries performed, total blood loss, tot al number of hospital days, and total number of hours in the operating room. Results: Of 39 vascularized bone grafts, two failed (95% succes s rate), whereas of 29 nonvascularized bone grafts, seven failed (76% success rate). Failure for the nonvascularized bone grafts was closely correlated to the length of the defect. Nonvascularized bone graft pa tients underwent an average of one more surgical procedure for total r econstruction than vascularized bone graft patients, including osseoin tegrated implants. However, vascularized bone graft patients spent a m ean of over 14 additional days in the hospital for all of their recons tructive procedures and an additional 3 hours in the operating room as compared with nonvascularized bone graft patients. Blood loss was sim ilar in both groups (1,100 mi). Only 20% to 24% of patients in each tr eatment group have completed reconstruction to include osseointegrated implants. Conclusions: The success rate for vascularized bone graftin g is high and is the treatment of choice when primary reconstruction i s required, when the patient has been previously irradiated, or when s imultaneous replacement of soft tissue is required. Vascularized bone grafts are also the treatment of choice for mandibular replacements ov er 9 cm in length. Nonvascularized bone grafts create a better contour and bone volume for facial esthetics and subsequent implant insertion , and may be the treatment of choice for secondary reconstruction of d efects less than 9 cm in length.