Three-phase bone scintigraphy and viability of vascularized bone grafts for mandibular reconstruction

Harada, Hiroyuki; Takinami, S; Makino, Sajiro; Kitada, Hideaki; Yamashita, Tomomi; Notani, Ken‐ichi; Fukuda, Hiroshi; Nakamura, Motoyasu

doi:10.1016/s0901-5027(00)80029-6

Cited by 15 publications

(6 citation statements)

References 15 publications

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“…However, other authors who performed sequential bone scans did not find any false positive in their study. [ 4 6 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 12 ] in their study on 36 patients showed that transplant to cranium (T/C) ratio of more than one had uncomplicated healing compared with those showing T/C ratio of less than one especially in immediate postoperative period. Harada et al .,[ 4 ] in their study, performed sequential bone scan in ten patients till 1-year and found it very helpful in assessing the viability and anastomotic patency of the bone flap.…”

Section: Discussionmentioning

confidence: 99%

“…Nuclear medicine imaging using 99m Tc methylene diphosphonate (MDP) can be used in detecting nonviability and is also helpful in postoperative follow-up of bone flaps used for mandibular reconstruction. [ 4 ] The vascular supply can also be assessed by angiography, duplex sonography, and radiography. We present a case report, which highlights the importance of 99m Tc MDP imaging in the assessment of the bone flap viability.…”

Section: Introductionmentioning

confidence: 99%

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Role of ^99m Tc-methylene diphosphonate bone scan in the evaluation of the viability of the bone flap in mandibular reconstruction in patients with oromaxillofacial malignancies

et al. 2015

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Osteo-cutaneous flap are commonly used for reconstruction of bone defect after oncology surgery. The success of surgery depends on the viability of the bone flap. Bone scan is a known, but less performed method, to look for viability of bone flaps. We describe a case of 50-year-old lady, presenting with squamous cell carcinoma of left buccal mucosa (cT4N1M0) involving the skin and mandible. She underwent left segmental mandibulectomy and upper alveolectomy with neck dissection, followed by reconstruction using a fibular osteo-cutaneous flap and anterolateral thigh free flap. On postoperative day 10, the intraoral flap showed signs of nonviability. The patient was sent to nuclear medicine for assessment of viability of the free fibula flap. The patient underwent three phase 99mTc-methylene diphosphonate (MDP) bone scan and single-photon emission computerized tomography. Computerized tomography showing good tracer uptake in fibula confirming viability. The case reflects the use of 99mTc-MDP in viability assessment of the bone flap.

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“…However, other authors who performed sequential bone scans did not find any false positive in their study. [ 4 6 ]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Role of ^99m Tc-methylene diphosphonate bone scan in the evaluation of the viability of the bone flap in mandibular reconstruction in patients with oromaxillofacial malignancies

et al. 2015

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“…Three phase bone scintigraphy is an accepted diagnostic modality for the evaluation of (non-vascularized) bone grafts of mandibular defects (6,11,14,17,19,26,33). In a previous study (1) and based on experiences of daily routine working we found three phase bone scintigraphy too unsensitive for the successful evaluation of the muscular part of the transplant in the immediate postoperative period.…”

Section: Discussionmentioning

confidence: 99%

18F-FDG PET: early postoperative period of oro-maxillo-facial flaps

Aigner

Schultes²,

Wolf³

et al. 2003

Nuklearmedizin

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Summary: Aim: We addressed the feasibility of FDG-PET to differentiate between viability and non-viability in the immediate postoperative assessment of flaps (autologous microvascular anastomosed pedicled flaps) in oro-maxillo-facial surgery. Methods: 3-7 days after surgery, FDG-PET was done in 38 patients who had received flaps for reconstruction of the mandible after partial resection. The studies were done on a dedicated full ring PET-scanner (ECAT EXACT HR+, Siemens/CTI). Acquisition started between 60 and 80 min post injection. The findings of the soft tissue component of the flaps were grouped using a three point scale: (I) no defect, (II) small defects, (III) one large defect. The results of PET were compared with the clinical course for at least 3 months. Results: “No defect” on the FDG-PET study identified viability of the flap and predicted normal clinical follow-up (22/38 patients). “Small defects” visualized areas of decreased perfusion and decreased glucose metabolism indicating risk of non-viability (13/38 patients); adapting the postsurgical management led to delayed but uncomplicated healing of the flaps in these patients. “One large defect” demonstrated early necrosis of the flap (3/38 patients). After removal and replacement of this necrotic portion of the flap the second FDG-PET scan of these 3 patients demonstrated the uncomplicated post-operative healing. Conclusion: FDG-PET facilitated the assessment of viability and non viability of flaps in the immediate postsurgical period, and demonstrated the usefulness of FDG-PET for postoperative care and prognosis.

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“…Unlike computed tomography (CT) and magnetic resonance imaging (MRI), scintigraphy is not affected by metal implants used to fix fractures. Bone scintigraphy has been shown to be a useful method for determination of the outcome of graft healing [5]. On the other hand, we learned from our daily routine and documented in a previous study [6] that three-phase bone scintigraphy is of less diagnostic value in the early and sensitive recognition of complications involving the soft tissue portion of flaps.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic and prognostic value of 99mTc-tetrofosmin scintigraphy in maxillofacial flaps

Aigner

Schultes

Sorantin

2003

Eur J Nucl Med Mol Imaging

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In oro-maxillofacial malignancies, new therapeutic approaches are placing changing demands on the diverse diagnostic modalities. In contradistinction to mandibular reconstruction of former years, the transplants (microvascular anastomosed pedicled flaps, "flaps") now consist of one or more arteries feeding a soft tissue component attached to a piece of bone suitably fitted to fill the defect. We addressed the diagnostic value of technetium-99m tetrofosmin scintigraphy in differentiating between viability and non-viability of the soft tissue portion of flaps in the immediate postoperative assessment. A total of 60 patients who had received flaps for reconstruction of the mandible after partial resection were investigated with (99m)Tc-tetrofosmin 3-5 days after surgery. Scintigraphy consisted of (a) radionuclide angiography, (b) static planar imaging in four projections starting at 10 min post injection, and (c) single-photon emission tomography (SPET) performed immediately after the planar imaging. Normal perfusion associated with no defects throughout the soft tissue portion of the transplant was observed in 46/60 patients. This scintigraphic pattern was identical to viability and normal postoperative follow-up. Hypoperfusion and small defects on planar and SPET images indicated viability and uncomplicated postoperative healing in 6/60 patients, but non-viability/inadequate healing of the flap in 4/60 patients. Absence of perfusion combined with a large defect on static planar and SPET images definitively showed the non-viability of the flap (4/60 patients). It is concluded that (99m)Tc-tetrofosmin scintigraphy is a sensitive diagnostic tool for the immediate postoperative assessment of the viability and the adequacy of implantation of the soft tissue portion of flaps. Therefore tetrofosmin scintigraphy is an important modality in order (a) to define the optimal therapeutic regimen in the immediate postoperative period and (b) to provide better prognosis.

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Three-phase bone scintigraphy and viability of vascularized bone grafts for mandibular reconstruction

Cited by 15 publications

References 15 publications

Role of ^99m Tc-methylene diphosphonate bone scan in the evaluation of the viability of the bone flap in mandibular reconstruction in patients with oromaxillofacial malignancies

Role of ^99m Tc-methylene diphosphonate bone scan in the evaluation of the viability of the bone flap in mandibular reconstruction in patients with oromaxillofacial malignancies

18F-FDG PET: early postoperative period of oro-maxillo-facial flaps

Diagnostic and prognostic value of 99mTc-tetrofosmin scintigraphy in maxillofacial flaps

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Three-phase bone scintigraphy and viability of vascularized bone grafts for mandibular reconstruction

Cited by 15 publications

References 15 publications

Role of 99m Tc-methylene diphosphonate bone scan in the evaluation of the viability of the bone flap in mandibular reconstruction in patients with oromaxillofacial malignancies

Role of 99m Tc-methylene diphosphonate bone scan in the evaluation of the viability of the bone flap in mandibular reconstruction in patients with oromaxillofacial malignancies

18F-FDG PET: early postoperative period of oro-maxillo-facial flaps

Diagnostic and prognostic value of 99mTc-tetrofosmin scintigraphy in maxillofacial flaps

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Role of ^99m Tc-methylene diphosphonate bone scan in the evaluation of the viability of the bone flap in mandibular reconstruction in patients with oromaxillofacial malignancies

Role of ^99m Tc-methylene diphosphonate bone scan in the evaluation of the viability of the bone flap in mandibular reconstruction in patients with oromaxillofacial malignancies