Clinical effectiveness of 99mTc-diphosphonate scintigraphy of revascularized iliac crest flaps.
Clinical assessment of the perfusion of the musculocutaneous portion of composite iliac crest free flaps was compared to 99mTc-diphosphonate (HDP) uptake in 14 patients who underwent primary oromandibular reconstruction after ablative cancer surgery. Bone scanning was performed on average at the 9-10th postoperative day (range 4-48) 3 h after intravenous injection of 550 MBq 99mTc-HDP. Eleven patients showed complete concordance between 99mTc-HDP uptake and soft-tissue status. Two patients showed uptake and viable muscle in spite of necrotic skin. One patient had a viable musculocutaneous flap but a photopenic defect in the bone graft; 6 months later, a small corresponding part of the bone was sequestrated. In this study, bone scanning and clinical assessment of muscle perfusion were 100% accurate in predicting viability of bone grafts. Skin viability was a less reliable parameter. It is concluded that bone scanning is not indicated as a routine investigation for revascularized iliac crest flaps and that clinical assessment of muscle perfusion is a reliable monitor of the early function of such flaps.
Smeele
L E
LE
Department of Oral and Maxillofacial Surgery, Academisch Ziekenhuis Vrije, Universiteit, Amsterdam, The Netherlands.
Hoekstra
O S
OS
Winters
H A
HA
Leemans
C R
CR
D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000000981:diagnostic imaging* / Q000473:pathology; D004164:Diphosphonates / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007085:Ilium; D007275:Injections, Intravenous; D008297:Male; D008339:Mandibular Neoplasms / Q000534:rehabilitation / Q000601:surgery; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000534:rehabilitation / Q000601:surgery; D018482:Muscle, Skeletal / Q000098:blood supply / Q000000981:diagnostic imaging / Q000637:transplantation; D009336:Necrosis; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D015203:Reproducibility of Results; D016038:Skin Transplantation / Q000000981:diagnostic imaging / Q000473:pathology; D013524:Surgical Flaps / Q000098:blood supply / Q000473:pathology; D017556:Technetium Compounds / Q000008:administration & dosage; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
D004164:Diphosphonates; D019275:Radiopharmaceuticals; D017556:Technetium Compounds; C029045:technetium Tc 99m diphosphonate