RECONSTRUCTION OF MANDIBULAR DEFECTS USING INDIVIDUAL VASCULARIZED AUTOGRAFTS COMBINED WITH MACROPOROUSTITANIUM FIBER MA

Abstract

— The choice of donor material poses a problem for surgeons handling reconstruction of large combined bone defects or limited maxillofacial bone defects. Restoration methods, applicable in reconstructive microsurgery are based on materials of non-biological origin and musculoskeletal autogenous transplants which have complications and may inhibit the processes of osseointegration. Our study aimed to improve the efficiency of surgical treatment and rehabilitation of patients with mandibular defects using vascularized autograft in combination with macroporous titanium fiber material. The reconstruction of the defective mandible caused by chronic osteomyelitis, trauma, benign tumors was performed in 107 patients either by means of conventional methods (titanium plates, free and vascularized bone autografts), or by a novel engineered bone substitute. Our novel vascularized bone autotransplant combines a macroporous fiber titanium material and spiral bone autochips. For its fabrication we applied digital 3D technologies and methods of rapid prototyping, whereas its vascularization was harvested in iliac crest. Unlike the standard methods of reconstruction, the use of the engineered vascularized implant showed a significant reduction in stages, volume and invasiveness of surgical procedures and an improvement of esthetic and functional outcomes in patients with mandibular defects.