Mandibular reconstruction with free iliac bone grafting

Transplantation of the iliac bone graft for mandibular reconstruction for the treatment of mandibular tumors. Treatment of diseases: oral and maxillofacial tumors Indication The mandibular reconstruction of the iliac bone graft is suitable for all cases of benign tumor resection. In low-grade cases, bone grafting can be performed immediately. Contraindications Jaw cancer with high degree of malignancy should not be implanted immediately after resection. Patients who are over-aged, have poor health, or have long-term surgery for heart and lung disease, can delay bone grafting. Preoperative preparation In addition to making a beveled guide or a winged splint, if there are enough teeth available, a dental splint can be made. Skin preparation 1 day before surgery, the range is abdominal and ipsilateral thighs before and after shaving pubic hair. Surgical procedure Tibial cutting method The tibia is divided into body and wing, one on each side, and participates in the formation of the pelvis. The body is below, connected to the ischium and pubic bone, and is part of the medullary ridge. The wings are above and large and flat, both inside and outside. The gluteus maximus and gluteus maximus are attached to the outside, and the medial side is mainly the diaphragm. The upper boundary of the two sides is , curved, the front end is inward of the anterior superior iliac spine, the posterior end is called the posterior superior iliac spine, the iliac crest has internal and external lips, and the inner lip is attached with the transverse abdominis muscle and the lumbar muscle. , diaphragm and so on. The outer lip is accompanied by tensor fascia lata, extra-abdominal oblique muscle, latissimus dorsi and fascia lata, and the intra-abdominal oblique muscle is attached between the lips. The position is superficial, external, and easy to touch, which is an important anatomical landmark. Generally, the ipsilateral humerus is cut. The inner skin of the ankle is compressed and the skin of the ankle is displaced to the medial side. Then, according to the length of the bone, the skin, the subcutaneous tissue and the muscles covering the tendon are cut along the tendon to reach the surface of the tibia. Such a cutting method is advantageous in that the knife edge is not directly cut on the sputum. When the inner skin of the compressed iliac crest is loosened, the incision is located on the outer side of the iliac crest, which will prevent the incision after healing from being directly subjected to pressure and friction. . After hemostasis, the wound edge is pulled to both sides to fully expose the sputum, and then the periosteum is cut along the iliac crest, and the muscles attached to the inner and outer lips of the iliac crest are cut. Continue to use the periosteal separator to separate the iliac crest and the medial and lateral periosteum and muscle iliac below and to the sides until the desired bone extraction range is obtained. The osteotomy is divided into full-thickness cutting and fault-cutting. (1) Full-layer cutting method: use the electric saw to self-twist the front edge of the front and back, and make the upper and lower vertical saws on both sides according to the required length. After reaching a certain depth, the lateral bone surface is cut and cut from the lateral bone surface, and finally the bone is changed. The chisel is cut transversely from the corresponding part of the medial bone surface, and the whole piece including the flap bone plate and the cancellous bone are removed with an osteotome. The bone wax was used to completely stop the bleeding. After the wound was washed, a half-tube drainage strip was placed, and the periosteum, muscle layer, subcutaneous tissue and skin were sutured layer by layer. The suture is placed with an ethanol gauze, covered with gauze, sealed with a wide tape, and finally pressure-wrapped. (2) partial humeral or humeral or half-slice resection: use the electric saw to cut the size, thickness, length and width of the desired bone graft, and drill it at the medial side of the iliac crest and the medial plate of the flap. Cut into the desired shape, then use a wide-bone knife, insert it from the inside of the inside of the sputum, and force it to the inside to break it and take it out. The same method used bone wax to completely stop bleeding, set the flow strip, and layered tightly. The medial bone surface of the iliac crest is easier to separate from the outer side surface. Because the gluteal muscle is closely attached to the lateral side, the inner side of the iliac crest is preferred when the tibial slice is removed. 2. Tibial Implantation The preparation of the bone graft area is prepared with the rib bone graft. Tibial implants are mainly embedded. Before implantation, first use the rongeur to flatten one or both sides of the bone fracture surface, and then repair the section of the bone graft to make it fit to the end of the broken bone wound. Then use an electric drill (using a small split drill) to drill one hole up and down 0.5cm from the buccal side of the fracture surface of one or both sides, and drill a hole in the corresponding part of the humeral block, and then penetrate the stainless steel wire. It is fixed by tightening and ligation; it can also be fixed by micro steel plate. After the wound is washed, the wound is divided into three layers of muscle layer, subcutaneous tissue and skin. The rubber strip is placed with a partial light pressure bandage. complication After the reconstruction of mandibular reconstruction with iliac bone graft, the wound hemorrhage flows to the posterior ventral wall, which is easy to be complicated with hematoma after abdominal wall. Cut off the external sacral nerve, local skin numbness.