Autologous freeze-treated bone for mandibular reconstruction after malignant tumor resection: a study of 72 patients

Free Periosteal Flaps with Scaffold: An Overlooked Armamentarium for Maxillary and Mandibular Reconstruction

“…The radial periosteum was used to wrap the inner surface of the replaced mandible, while the residual periosteum of the outer surface, if preserved, returned to its original place, over the outer surface of the mandible. In these experiences the surgical success was mild: indeed, while Roselli et al and Calabrese et al, on very small series of cases reported a 100% of scaffold integration, despite some immediate and late complications, Cantù and colleague described an almost 40% of scaffold removal [6][7][8]. The most important complication was the breakdown of soft tissue suture with infection of the frozen bone graft.…”

“…The most important complication was the breakdown of soft tissue suture with infection of the frozen bone graft. The authors did not noted differences between the use of a free flap with or without periosteum because the revitalization is long term procedure requiring several months [8], whereas the wound dehiscence normally occurs within a few days, when the bone is not yet revitalized. Moreover, postoperative radiotherapy increased the rate of failure, because it decreases the revascularization of the bone.…”

“…Kelley et al firstly proposed the use of FPF in a case midface reconstruction, to optimize the vascularization of an autologous bone graft [5]. Afterwards, several authors proposed a more refined technique with FPF with autologous frozen bone for segmental mandibulectomy [6][7][8]. The first case series belong to Roselli and colleagues and Calabrese and colleagues [6,7].…”

“…The first case series belong to Roselli and colleagues and Calabrese and colleagues [6,7]. Subsequently Cantù et al reported a comparative experience on a group of 72 patients who had undergone to mandibular restoration with assorted techniques: among them, 33 underwent reconstruction with a fasciocutaneous forearm FPF associated with autologous frozen bone graft [8]. After mandibular resection, the technique described was based on detaching the soft tissues from the resected mandible, leaving on site the periosteum of the outer surface of the mandible, if oncologically safe.…”

“…Revascularized FPF with support scaffold can represent a possible alternative in decision making algorithm for complex patients, BFF's failure and disease recurrence, being more versatile than other less sophisticated choices such as pedicled flaps with reconstructive plates. However, only few clinical applications in head and neck reconstruction are reported in the literature [5][6][7][8][9][10][11].…”