Eric R Carlson1, Kevin Monteleone. 1. Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville 37920, USA. ecarlson@mc.utmck.edu
Abstract
PURPOSE: This article reports on the incidence and outcome of inadvertent perforations of mucosa and skin during the reconstruction of segmental defects of the mandible using cancellous cellular bone. PATIENTS AND METHODS: This study reviews 11 patients experiencing an inadvertent perforation of skin and/or mucosa among 211 consecutive patients (5.2%) undergoing reconstruction of the mandible with this graft model. RESULTS: Eleven patients experienced 16 perforations of either mucosa (n = 14) or skin (n = 2). Six diagnoses necessitated these 11 reconstructions where a perforation was encountered, including ameloblastoma (n = 3), chronic osteomyelitis (n = 2), stage III osteoradionecrosis (n = 2), fibrosarcoma (n = 1), synovial cell sarcoma (n = 1), stage IV squamous cell carcinoma (n = 1), and odontogenic myxoma (n = 1). Fourteen of the 16 perforations occurred intraoperatively, and 2 occurred postoperatively (dehiscence). Eleven of the 16 perforations occurred at either the distal or proximal segment, while 5 of the perforations occurred in the mid portion of the segmental defect tissues. Postreconstruction follow-up ranged from 11 to 70 months (mean, 28.5 months). Infection occurred in 1 of the 11 patients (9.1%) with resultant partial graft loss. Protocols are proposed that serve to preserve a contamination-free tissue bed and minimize or eliminate infection of the graft when a perforation is encountered. CONCLUSION: An inadvertent perforation of mucosa or skin does not result in automatic graft infection and failure when proper intraoperative management is carried out. When the graft perforates through the mucosa postoperatively, proper wound management similarly can preserve the graft. This information reinforces the fact that it is not necessary to abort reconstructive surgery once a perforation is identified intraoperatively, nor to debride an entire graft that becomes exposed postoperatively.
PURPOSE: This article reports on the incidence and outcome of inadvertent perforations of mucosa and skin during the reconstruction of segmental defects of the mandible using cancellous cellular bone. PATIENTS AND METHODS: This study reviews 11 patients experiencing an inadvertent perforation of skin and/or mucosa among 211 consecutive patients (5.2%) undergoing reconstruction of the mandible with this graft model. RESULTS: Eleven patients experienced 16 perforations of either mucosa (n = 14) or skin (n = 2). Six diagnoses necessitated these 11 reconstructions where a perforation was encountered, including ameloblastoma (n = 3), chronic osteomyelitis (n = 2), stage III osteoradionecrosis (n = 2), fibrosarcoma (n = 1), synovial cell sarcoma (n = 1), stage IV squamous cell carcinoma (n = 1), and odontogenic myxoma (n = 1). Fourteen of the 16 perforations occurred intraoperatively, and 2 occurred postoperatively (dehiscence). Eleven of the 16 perforations occurred at either the distal or proximal segment, while 5 of the perforations occurred in the mid portion of the segmental defect tissues. Postreconstruction follow-up ranged from 11 to 70 months (mean, 28.5 months). Infection occurred in 1 of the 11 patients (9.1%) with resultant partial graft loss. Protocols are proposed that serve to preserve a contamination-free tissue bed and minimize or eliminate infection of the graft when a perforation is encountered. CONCLUSION: An inadvertent perforation of mucosa or skin does not result in automatic graft infection and failure when proper intraoperative management is carried out. When the graft perforates through the mucosa postoperatively, proper wound management similarly can preserve the graft. This information reinforces the fact that it is not necessary to abort reconstructive surgery once a perforation is identified intraoperatively, nor to debride an entire graft that becomes exposed postoperatively.