Reconstruction of craniofacial bony defects using autogenous bone grafts: a retrospective study on 233 patients.

For the reconstruction of extensive craniofacial bony defects, autogenous bone is the material of choice because of its potential for revascularization and its osteoconductive and osteoinductive properties. In the present study, the results obtained after grafting with autogenous bone grafts in 233 patients with facial bony defects are analyzed retrospectively. At the Department of Maxillo-Facial Surgery of the University of Rome "La Sapienza," 233 patients (127 males and 106 females) with defects in the craniofacial regions have been reconstructed using autogenous bone grafts between 1997 and 2003. Bone grafts have been obtained from calvaria (N = 29), rib (N = 35), and iliac crest (N = 169). Fixation methods were wire fixation in 72 patients treated between 1977 and 1991 and rigid internal fixation in the 161 patients treated between 1992 and 2003. In 215 cases (92%), an adequate integration of the graft at the recipient site was observed. Complications such as infection and graft resorption requiring graft removal were experienced in seven of 72 patients in which bone grafts have been fixed with wire fixation (9.7%) and in 11 of the 161 patients in which bone grafts have been fixed with rigid internal fixation (6.4%). Even today, revascularized free flaps are the first choice in case of extensive bony defects; in selected cases, bone grafts continue to represent a valid therapeutic option.