Donor Site Morbidity of Nonvascularized Bone Graft: A Systematic Review – ScienceOpen
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      Donor Site Morbidity of Nonvascularized Bone Graft: A Systematic Review

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          Abstract

          ABSTRACT Objective: To evaluate the donor site morbidity of iliac and fibular nonvascularized bone graft after mandibular resection. Material and Methods: This study was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in PubMed, Proquest, Science Direct, and Ebsco. A total of 12 studies met the criteria of studies in humans using iliac and fibular nonvascularized bone grafts in mandibular reconstruction after mandibular resection. Results: A greater proportion of patients received iliac nonvascularized bone graft (88.9%) than fibular nonvascularized bone graft (11.1%). Of the 385 cases of iliac bone graft, 153 cases (40%) experienced complications at the iliac donor site, whereas in 48 cases of fibular bone graft, two (4%) experienced complications at the donor site. Hemorrhage, bone fracture, infection requiring debridement, and hematoma were the major complications. Conclusion: The morbidity rate of the nonvascularized bone graft donor site of the fibula (4%) tended to be lower than that of the ilium (40%). Patient age and defect size were not significantly correlated with the occurrence of morbidity donor sites in either the ilium or fibula.

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          Bone regenerative medicine: classic options, novel strategies, and future directions

          This review analyzes the literature of bone grafts and introduces tissue engineering as a strategy in this field of orthopedic surgery. We evaluated articles concerning bone grafts; analyzed characteristics, advantages, and limitations of the grafts; and provided explanations about bone-tissue engineering technologies. Many bone grafting materials are available to enhance bone healing and regeneration, from bone autografts to graft substitutes; they can be used alone or in combination. Autografts are the gold standard for this purpose, since they provide osteogenic cells, osteoinductive growth factors, and an osteoconductive scaffold, all essential for new bone growth. Autografts carry the limitations of morbidity at the harvesting site and limited availability. Allografts and xenografts carry the risk of disease transmission and rejection. Tissue engineering is a new and developing option that had been introduced to reduce limitations of bone grafts and improve the healing processes of the bone fractures and defects. The combined use of scaffolds, healing promoting factors, together with gene therapy, and, more recently, three-dimensional printing of tissue-engineered constructs may open new insights in the near future.
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            Mandibular reconstruction: meta-analysis of iliac- versus fibula-free flaps.

            Free vascularized bone flaps are widely recognized as the optimal reconstruction for patients who undergo mandibular resection. The fibula-free flap is currently considered the gold standard, workhorse flap for mandibular reconstruction. Although previous studies have analysed individual success of each flap type, few have compared iliac- and fibula-free flaps.
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              Vascularized versus Nonvascularized Bone Grafts: What Is the Evidence?

              Background There is a general perception in practice that a vascular supply should be used when large pieces of bone graft are used, particularly those greater than 6 cm in length for long-bone and large-joint reconstructions. However, the scientific source of this recommendation is not clear. Questions/purposes We wished to perform a systematic review to (1) investigate the origin of evidence for this 6-cm rule, and (2) to identify whether there is strong evidence to support the importance of vascularization for longer grafts and/or the lack of vascularization for shorter grafts. Methods Two systematic reviews were performed using SCOPUS and Medline, one for each research question. For the first research purpose, a review of studies from 1975 to 1983 matching article title (“bone” and “graft”) revealed 725 articles, none of which compared graft length. To address the second purpose, a review of articles before 2014 that matched “bone graft” AND (“vascularised” OR “vascularized”) AND (“non-vascularised” OR “non-vascularized”) revealed 633 articles, four met prespecified inclusion criteria and were evaluated qualitatively. MINORS ratings ranged from 16 to 18 of 24, and National Health and Medical Research Council [NHMRC] Evidence Hierarchy ratings ranged from III-2 (comparative studies without concurrent controls) to III-3 (comparative studies with concurrent controls). Results No evidence was found that clarified grafts longer than 6 cm should be vascularized. The first reference to the 6-cm rule cites articles that do not provide strong evidence for the rule. Of the four articles found in the second systematic review, none examined osseous union of vascularized and nonvascularized grafts with respect to length. One study (III-3, MINORS 18 of 24) of fibular grafts to various limb defects found that vascularization made no difference to union rate or time to union. Vascularized grafts were more likely to require surgical revision for wound breakdown, nonunion, graft fracture, or mechanical problems (hazard ratio [HR], 5.97, p = 0.008) and grafts smaller than 10 cm had fewer complications requiring revision (HR, 0.88; p = 0.03). Three studies (III-2 to III-3, MINORS 16 to 18 of 24) that examined fibular grafts to the femoral head found that vascularized grafts had superior Harris hip and pain scores. Two of the three articles showed that vascularization was associated with superior radiologic measures of collapse progression. Conclusions No compelling evidence was found to illuminate the origin of the 6-cm rule for vascularized bone grafts, or that such a rule is based on published research. The evidence we found for grafts to long-bone defects suggested that vascularization might increase the risk of complications that require a surgical revision without increasing union rates or time to union. For large joints, vascularization may result in better functional scores and pain scores, while the evidence that they improve radiologic measures of progression is mixed. There were no studies of long-bone or large-joint reconstructions that examined the role of length with respect to osseous union. We suggest that future studies should present data for graft lengths quantitatively and with individual data points rather than categories of length ranges. Level of Evidence Level III, therapeutic study.
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                Author and article information

                Journal
                pboci
                Pesquisa Brasileira em Odontopediatria e Clínica Integrada
                Pesqui. Bras. Odontopediatria Clín. Integr.
                Associação de Apoio à Pesquisa em Saúde Bucal (João Pessoa, PB, Brazil )
                1519-0501
                1983-4632
                2023
                : 23
                : e220029
                Affiliations
                [1] orgnameUniversitas Indonesia orgdiv1Faculty of Dentistry orgdiv2Department of Oral and Maxillofacial Surgery Indonesia
                Article
                S1983-46322023000100702 S1983-4632(23)02300000702
                10.1590/pboci.2023.033
                7e52284a-2b5e-459d-9f1b-49ed1d8d64f3

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 17 July 2022
                : 09 February 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 33, Pages: 0
                Product

                SciELO Brazil

                Categories
                Systematic Review

                Fibula,Ilium,Bone Transplantation,Morbidity,Mandibular Reconstruction

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