[Postoperative monitoring of free fibular grafts by dynamic magnetic resonance imaging. Preliminary results in three cases of mandibular reconstruction].
The vascularized free fibular graft has been used in mandibular reconstructive surgery since 1975. This technique has been progressively developed, and it is now the procedure of choice for mandibular reconstruction although in certain postoperative circumstances it can be difficult if not impossible to monitor bone vitality. However, bone vascularization can be detected by dynamic magnetic resonance imaging (MRI), as this technique has been experimentally and clinically validated in the early diagnosis of osteonecrosis. The aim of this study was to evaluate the efficacy of MRI for the postoperative monitoring of vascularized free fibular grafts in human mandibular reconstruction. Dynamic contrast-enhanced MRI was used to study the variation in contrast over time following injection of gadolinium contrast medium, and to evaluate the degree of bone marrow perfusion of the fibular graft. This variation in signal intensity was visualized in the form of a curve, i.e., a perfusion curve for the bone marrow region. An examination was performed in three patients at different postoperative times and under different conditions. In one case, MRI confirmed the presence of fibula blood supply in spite of the necrosis of the adjacent fascio-adipose layer. In this article, the methodological difficulties have been discussed, particularly as regards data processing, and the present results have been compared with the findings in the literature. Dynamic MRI is a simple, reliable, non-invasive technique and its use in the postoperative monitoring of bone marrow perfusion and vascularized free fibular grafts permits a determination of the status of the latter following surgery, i.e., whether there is an adequate blood supply or not.
Service de chirurgie plastique, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94100 Saint-Mandé, France.
E
E
Bey
A
A
Paranque
C
C
Pharaboz
J L
JL
Cariou
D000368:Aged; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods; D003287:Contrast Media; D005360:Fibula / Q000637:transplantation*; D006084:Graft Rejection / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008334:Mandible / Q000601:surgery*; D008536:Meglumine; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D009942:Organometallic Compounds; D011182:Postoperative Care / Q000379:methods*; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; C072417:gadoterate meglumine