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Craniomaxillofacial Reconstructive and Corrective Bone Surgery - part 8

Các nhà tài trợ khác nhau cho ghép xương tự thân đã được đề xuất và được sử dụng bao gồm cả chậu trước và đằng sau đỉnh, 112.113 xương sườn, 113 hàm dưới,114-117 calvarium, 82.118 xương chày, 83 nắp periosteal,119-121 và periosteal grafts.120, 122.123 Các quyết định ủng hộ một hoặc các trang web | 544 K. Honigmann and A. Sugar Different donor sites for autologous bone grafts have been proposed and used including anterior and posterior iliac crest 112 113 rib 113 mandible 114-117 calvarium 82 118 tibia 83 periosteal flaps 119-121 and periosteal grafts.120 122 123 The decision in favor of one or other of the different donor sites depends among other things on the age of the patient at operation that is the quantity of cancellous bone at the different donor sites in different ages. In an optimal recipient site one can obtain good results with every graft although autologous cancellous bone is the most proven successful graft. With it one can fill out the defect completely. It allows vessels to grow into the graft from the recipient site and to transform the graft into the locally adapted bone in the easiest and most rapid way. Moreover cancellous bone has the highest resistance against infection. In patients older than 2 years cancellous bone can be harvested from the iliac crest with the help of a trocar Figures 48.2 and 48.3 . This procedure diminishes the extension of the secondary intervention and the pain at the donor site and the resulting graft is compressed. Alternatively and especially when large quantities are required the iliac crest itself can be raised as an osteoplastic flap cancellous bone chips removed and the lid replaced. The key to prevention of postoperative morbidity at this site is the avoidance of any muscle stripping in particular on the lateral aspect of the crest and the use of a long-acting local anesthetic agent e.g. bupivicaine titrated over 24 hours postoperatively into the wound via an epidural cannula. Adequate stability is always important especially in bilateral alveolar clefts. During the first postoperative weeks bone grafting cannot abolish the mobility of the premaxilla. Indeed mobility of the fragments may well prevent bone union between the fragments and across the cleft s . Some form of fixation of the fragments is .