title: Nonvascularized iliac bone grafts for mandibular reconstruction--requirements and limitations.
abstract: BACKGROUND
  Treatment of intraoral malignant tumors often leads to continuity defects of the mandible. Whereas the use of free vascularised flaps has shortcomings regarding donor site morbidity and a worse-fitting bone geometry, the nonvascularized iliac crest graft could be an alternative option. The purpose of this study was to describe the treatment outcome with nonvascularized iliac crest grafts over a 10-year period and to determine possible limitations of their use.
  
  
  METHODS
  Eighty-four patients with bicortical nonvascularized iliac crest grafts for mandibular reconstruction were examined at least one year after reconstruction. Patients' records and the radiological and/or surgical data were analyzed.
  
  
  RESULTS
  Sixty-three patients (75%) showed complete healing, in 20 patients the treatment was not successful and in one patient the treatment result was unclear. Interestingly, comparing the successfully and the unsuccessfully treated patients, only the irradiation dose played a crucial role. Neither defect length nor defect localisation, nor time interval between resection and reconstruction were statistically significant parameters in graft success. Comparing only patients with malignancies, the non-irradiated patients had a higher success rate (77.3%).
  
  
  CONCLUSIONS
  The nonvaslcularized iliac crest graft seems to be a reasonably reliable treatment option for reconstruction of mandibular defects up to about 5-6 cm in size. Radiotherapy is a strong confounder reducing the success rate. Necessary constraints are sufficient soft tissue conditions. However, primary reconstruction by free flaps (e.g. fibula flap) has a higher success rate in literature and should be preferred whenever possible.
authors.affiliation: Department for Cranio- and Maxillofacial Surgery of Heinrich Heine University Düsseldorf, Moorenstr. 5 (Geb. 18.73), D-40225 Düsseldorf, Germany. handschel@med.uni-duesseldorf.de
authors.forename: Jörg
authors.initials: J
authors.lastname: Handschel
authors.forename: Hirama
authors.initials: H
authors.lastname: Hassanyar
authors.forename: Rita A
authors.initials: RA
authors.lastname: Depprich
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Ommerborn
authors.forename: Karl Christoph
authors.initials: KC
authors.lastname: Sproll
authors.forename: Matthias
authors.initials: M
authors.lastname: Hofer
authors.forename: Norbert R
authors.initials: NR
authors.lastname: Kübler
authors.forename: Christian
authors.initials: C
authors.lastname: Naujoks
mesh_terms: D000328:Adult; D000368:Aged; D000564:Ameloblastoma / Q000601:surgery; D016025:Bone Transplantation / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D003560:Cysts / Q000601:surgery; D005260:Female; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008297:Male; D008334:Mandible / Q000601:surgery*; D008336:Mandibular Diseases / Q000601:surgery; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D016896:Treatment Outcome