Evaluation of microvascular bone graft reconstruction of the head and neckwith 3-D Tc-99m-DPD SPECT scans

Objective. We conducted a prospective investigation to evaluate the diagnos tic accuracy of computer-aided 3-dimensional (3-D) technetium 99m dicarboxy propane methylene diphosphonate (Tc-99m-DPD) single photon emission compute d tomography (SPECT) reconstruction in the evaluation of microvascular bone flaps used for maxiliofacial reconstruction. Study design. Twenty patients who received 20 autogenous microvascular bone flaps for reconstruction of the mandible and maxilla were evaluated. Forty bone scans with subsequent computer-aided reconstruction were performed. E ach graft could, be assessed within 48 to 72 hours after surgery. The secon d bone scan was performed between 12 and 14 days after surgery. Results. Complications were observed in 5 grafts. SPECT investigation perfo rmed at the 2 time points after reconstruction showed a significantly highe r tracer uptake in grafts with an uncomplicated further course than in thos e that developed complications. Conclusions. Computer-aided 3D Tc-99m-DPD SPECT reconstruction serves as a useful prognostic tool and helps in the very early recognition of complicat ions. This technique adds significantly to the value of planar bone scintig raphy and conventional SPECT images.