Vascularized bone flaps versus nonvascularized bone grafts for mandibular reconstruction: An outcome analysis of primary bony union and endosseous implant success

Abstract

Background. Functional restoration following resection or traumatic injury to the mandible depends on the reliability of the bony reconstruction to heal primarily and support endosseous implants. Although vascularized bone flaps (VBF) and nonvascularized bone grafts (NVBG) are both widely used to reconstruct the mandible, indications for each remain ill-defined. The purpose of this study was to compare bone graft/flap healing and success of implant placement in patients reconstructed with VBF versus NVBG.Methods. Over the past 10 years, 75 consecutive mandibular reconstructions were performed (26 free bone grafts, 49 vascularized bone flaps). Etiology of the defect, history of irradiation, bone defect size, number of operations, graft/flap success, and dental implant success rates were determined and compared.

Vascularized versus Nonvascularized Bone Grafts: What Is the Evidence?

“…Four studies of fibular and iliac crest grafts to the mandible [20,35,41,50] and two studies of grafts from the iliac crest and radius to the scaphoid [7,37] that directly compared VBGs and NVBGs were identified and excluded from the search. These studies are inconclusive with respect to whether VBGs outperform NVBGs at increasing length, and are no basis to make clinical recommendations regarding long-bone and large-joint defects.…”

“…These studies are inconclusive with respect to whether VBGs outperform NVBGs at increasing length, and are no basis to make clinical recommendations regarding long-bone and large-joint defects. However, two of the mandibular studies [20,35] are unique in that they compare VBGs and NVBGs at different length categories; a feature needed in future long-bone and large-joint studies. In these studies, the grafts are divided into categories (\6 cm, 6-10 cm, 10-14 cm,[14 cm [20] and\6 cm, 6-9 cm, 9-12 cm,[12 cm [35]) and VBGs and NVBGs are compared.…”

“…However, two of the mandibular studies [20,35] are unique in that they compare VBGs and NVBGs at different length categories; a feature needed in future long-bone and large-joint studies. In these studies, the grafts are divided into categories (\6 cm, 6-10 cm, 10-14 cm,[14 cm [20] and\6 cm, 6-9 cm, 9-12 cm,[12 cm [35]) and VBGs and NVBGs are compared. Interestingly, one study identified a difference only for grafts greater than 6 cm, but not at individual graft categories such as 10 to 14 cm [20].…”

“…In these studies, the grafts are divided into categories (\6 cm, 6-10 cm, 10-14 cm,[14 cm [20] and\6 cm, 6-9 cm, 9-12 cm,[12 cm [35]) and VBGs and NVBGs are compared. Interestingly, one study identified a difference only for grafts greater than 6 cm, but not at individual graft categories such as 10 to 14 cm [20]. The other study found that as length increased for NVBGs, the rate of failure increased, but did not present the failure rate as VBG length increased [35].…”

“…This may translate to a longer or incomplete recovery. In practice and in modern research studies, defects larger than 5 to 7 cm generally have not been considered candidates for NVBGs [9,20,44]. However, the origin of the 6-cm rule is not readily apparent in those studies, which point to an array of articles that do not present relevant evidence (Fig.…”