ONE-STAGE (PRIMARY) RECONSTRUCTIONS OF RESECTION MANDIBULAR DEFECTS BY MEANS OF AUTOGENE VASCULARISED ILIAC AND FIBULAR TRANSPLANT.
Mandibular resections are most often performed in cases of tumour ablations. Contemporary oral and maxillofacial surgery acknowledges primary one-stage reconstructions of defects through microvscularised transplants. They have intact circulation due to the primarily performed vascular anastomoses. For recovery of the shape and the function of the mandible most frequently used transplants are derived from the iliac crest and fibula. Goal and objectives. We share our experience in the one-stage recovery of mandibular defects simultaneously with the resection, by means of autogene vascularised iliac and fibular transplants. Material and method. 8 patients aged from 24 to 61 (female - 1, male - 7) with tumours engaging the mandible (5 - benign and 2 - malignant) were treated surgically and followed up. We carried those out using extraoral approach in 7 cases, and intraoral aproach - in 1. The resulting post resection mandibular defects in 3 of the patients were reconstructed by means of one-stage autogene bone vascularised iliac transplants. In 5 patients the defects were recovered primarily through vascularised fibular autotransplants. The surgical techniques and protocols, to assess the outcome and characterize of the methods are presented.


RESULTS
We tracked down the postoperative results of the mandibular reconstructions for a period of 1 to 3 years. Support for the lips and tongue was achieved providing for satisfactory speech and feeding. Anatomical remodeling was observed. The conditions for the production of dental implants were improved. In the case, when we used intraoral approach the facial aesthetics was fully restored, as for the rest it was satisfactory.


CONCLUSIONS
Vascularised autogene iliac and fibular bone transplants are extremely appropriate for reconstructions of significant and complicated mandibular and other defects in the maxillofacial area. Their survival is independent from the recipient area, and secured through the vessel anastomoses. With sound surgical technique, success rate of the method is to a large extent guaranteed.
A
A
Dzhorov
R
R
Romansky
N
N
Yanev
V
V
Nikolov
S
S
Slavkov
D000328:Adult; D016025:Bone Transplantation / Q000379:methods; D005260:Female; D005360:Fibula / Q000098:blood supply / Q000637:transplantation*; D006801:Humans; D007085:Ilium / Q000098:blood supply / Q000637:transplantation*; D008297:Male; D008334:Mandible / Q000601:surgery*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D055815:Young Adult