[Long-term outcome of the donor site after free, microvascular pedicled iliac crest transplantation: experiences with 95 cases]. / Spätergebnisse an der Hebestelle nach freier, mikrovaskulär gestielter Beckenkammtransplantation: Erfahrung in 95 Fällen.

Using the anterior iliac crest as donor-site for free osseous, osseomuscular, and osseomyocutaneous flaps has proven itself an important reconstructive instrument both in maxillofacial and in orthopaedic surgery. We present a long-term retrospective evaluation of the donor-site situation after vascularized free anterior iliac crest transfer. The study is based in 95 cases from the years 1985 to 1993 including 11 cases from Switzerland (Kantonsspital Aarau). The patients were examined, looking for objective complications and asked questions about their subjective symptoms at the donor site. These objective and subjective results were then correlated. Herniation developed in 3% of cases, loss of sensibility in the region of the N. cutaneous femoris lateralis occurred in 9.5% and was in 6% reversible. Scars were in 7% aesthetically not satisfying with no keloids or hypertrophic scarring after all wounds healed per primam intentionem. Mostly minor alteration of the outer surface of the donor site was notable in 20 to 25% of the patients. Pain was a problem for an average of 7% of cases. Impairment in private life was named in 3.5%, in professional life in 4.7%, and in daily life in 11.9% of cases. Not content with the donor-site situation were 13.5%, not content with the preoperative information were 12% of the patients. Nonetheless were 98.8% of the patients willing to, if necessary, undergo the same operation again. Surprisingly, there is a negative correlation between objective and subjective results: Merely 25% of the patients with sensibility loss were not content with the donor-site result of the operation and vice versa only 1% of the dissatisfied patients had objectively measurable minor complications.

Histomorphometric examinations of free revascularised iliac crest bone after transplantation for mandibular reconstruction.

At the present time the vascularised bone graft is the best procedure for reconstruction of mandibular defects in poor recipient tissues. We obtained 23 drill biopsies from different regions of vascularised bone transplants during the removal of the osteosynthesis plates from 14 patients who had poor recipient tissues. For comparison, we took five biopsies from the native iliac crest and eight biopsies from six patients with avascular bone transfer into unimpaired surrounding tissues. Microradiographs of the bone preparations were used for a computerised semi-automatic morphometric analysis. We evaluated the volumetric density (VV, %) and the mean trabecular diameter (D-TRAB, micron). In the central regions, the revascularised transplants decreased in volumetric density and in mean trabecular diameter. Compared with the average values of iliac crest bone, the avascular grafts increased in both parameters. The revascularised grafts showed significantly lower volumetric density and significantly lower mean trabecular diameters in the central regions than in the regions near to the mandibular stump. The avascular grafts actually showed the reverse effect. The results are discussed with particular reference to the quality of the recipient tissues, to the maintenance of graft viability, to functional stress, and to the design of the transplant.

[Indications for 76 free surgical flaps for mandibular reconstruction]. / Indikation von 76 freien Lappen zur Unterkieferrekonstruktion.

Since 1985 76 revascularized osseous and osseocutaneous flaps collected from different donor sites were transferred. The overall rate of success amounted to 94.7%, 48.7% of the patients had previously undergone radiotherapy with tumor dose. Even though an elevated number of certain complications in cases of an irradiated recipient area occurred a critical analysis reveals the high value of the reanastomized flap in this situation. Proven indications are described in detail.

Histological evaluation of free revascularized iliac crest bone after transplantation for mandibular reconstruction.

Differing views on the nutritional status of revascularized bone in animal studies and in human transfer have been expressed. Normal viability is reported as well as single cell necrosis and devitalized areas and, finally, necrosis of the complete graft. From 19 patients with revascularized bone transfer into injured recipient tissues, we obtained 32 drill biopsies out of the centre of the graft and near the mandibular stump during the removal of the osteosynthesis plates. The histological preparations were examined for bone viability. In 58% of all patients, there occurred partial necroses in the grafted bone and in 26% single cell necroses; 16% of the transplants maintained normal viability. The areas with disturbed nutrition were found more frequently in peripheral areas than in central regions of the graft (p < 0.05, chi 2 test). The overall graft failure rate was 6.8%. The results of this clinical study are discussed with particular reference to the technical procedure, the recipient tissue quality, and the design of the graft. The indication for using revascularized bone transfer in difficult local conditions of the recipient tissues has been confirmed. The viability of the grafts cannot always be maintained entirely. The particular risk to the viability of the graft in the peripheral regions requires careful technical procedures.

[Osteomyocutaneous flap]. / Osteomyokutanlappen.

A method for the reconstruction of the bony chin contour with an iliac crest free flap is described. The skin pad may be used to replace mucosa or skin or both. Excessive bulk can be a problem, particularly where a relatively small bone and oral mucosal defect requires replacement. Attempts at minimizing this bulk risk the loss of blood supply to the overlying skin. Another procedure, such as the internal oblique-iliac crest osseomyocutaneous flap or inclusion of the thoracodorsal pedicle with the scapular osteocutaneous flap, should then be considered.

[Temporomandibular joint examination under general anesthesia--a case report]. / Zur Kiefergelenkuntersuchung in Allgemeinnarkose. Ein Fallbericht.

Surgical interventions involving the temporomandibular joint are subject to strict indications. It further requires the exhaustion of all conservative treatment possibilities before operative procedures are considered. This case report involves a patient with an impressive TMJ dysfunction. After a series of frustrating attempts at functional treatment, surgical intervention was finally decided. Under general anesthesia however, the patient examination showed not even the least pathologic change in the passive joint function. Besides considering the discrete signs of possible psychiatric-psychosomatic causalities for such alterations, it seems to us that a temporomandibular joint examination under general anesthesia in such suspected cases has a diagnostic and therapeutic significance.

The iliac crest region: donor site for vascularized bone periosteal and soft tissue flaps.

A review is presented of the classic vascularized iliac crest transfer and to show useful variations on this technique. A technical variation to reconstruct mandibular defects, the semisegmented iliac crest graft, is described. Another variation, the half iliac crest graft, is presented for use in the neovascularization of avascular necrosis of the femoral head. When such a flap is raised with a large periosteal flap and overlying muscle or skin, or both, as a composite flap, a primary osteoperiosteal tube can be created to reconstruct segmental defects in long bones. This primary osteoperiosteal tube is secondarily transformed into a completely osseous tube.

The importance of preoperative digital subtraction angiography in microsurgically reanastomosed tissue transfer.

The importance of preoperative digital subtraction angiography (DSA) in revascularized tissue transfer in the maxillofacial area is demonstrated on the basis of 53 flaps: In 7 cases DSA revealed results which influenced the therapeutic procedure. Compared to conventional methods of vascular diagnosis, DSA has considerable advantages.

[First results on the volumetric behaviour of osseous transplants after an avascular and reanastomosed transfer]. / Erste Ergebnisse zum Volumenverhalten der Knochenspäne nach avaskulärem und reanastomosiertem Transfer.

In this follow-up study the height of avascular and microsurgically reanastomosed osseous transplants serving for mandibular reconstruction is compared. For analysis a new computer-assisted method is applied which evaluates the plane of the transferred bone. As a result, it is revealed that the reanastomosed bone exhibits the better shape consistency than the avascular flap.

[Organ specific deposition of 45Ca labelled calcium phosphate ceramic material]. / Zur organspezifischen Ablagerung von 45Ca-markierter Kalziumphosphatkeramik.

Research work using easily resorbable HA- und TCP-ceramics does not give any proof for pathologic deposition in different organs. Based on current information, there is no objection against the clinical use of HA-ceramics.

[Application of granulate hydroxylapatite for mandibular augmentation]. / E epharmoge tou kokkode ydroxylapatite gia ten anypsose tes gnathikes akrolophias.

The already known surgical interventions for absolute induction of extensive mandibular atrophy, cannot be suggested as routine standardized methods. Use of Hydroxylapatite-ceramic for restoration of the atrophic alveolar process, shows several advantages; among those, simplicity of the operation use of local anesthesia, as well as very low percentage of unsuccessful interventions are taken into consideration. The clinical results of 102 cases are shown and discussed. Through the addition of H.A. ceramic in the field of preprosthetic surgery, there is a broadening of the spectrum of the therapeutic possibilities of patients with prosthetic problems to be expected.

[Augmentation of severely atrophied jaws with hydroxyapatite from a prosthodontics standpoint]. / Zur Augmentation des stark atrophierten Kiefers mit Hydroxylapatit aus prothetischer Sicht.

After 4 years of routine application of hydroxylapatite ridge augmentation 109 patients underwent a posttreatment examination. The quality of the alveolar ridge and the denture as well as the functional status of the craniomandibular system were evaluated in detail. For the maxilla good results were obtained in 80-90%, for the mandible in 70-80%. Further improvements seem more probable by the avoidance of prosthodontic faults and the elimination of functional disturbances than by additional surgical procedures such as vestibuloplasty.