An interesting case of autografting
December 17, 2007 § 7 Comments
This autumn I had the privilege of documenting several operations for head and neck cancer. Some of the most fascinating operations involved the use of an autograft to replace the resected cancerous structures.
One of these operations was performed on a patient with cancer of the gingiva (gums). The tumor had infiltrated the mandibular bone and the surgeons had decided to remove the tumor and a part of the mandible.
Mandibulectomy and reconstruction with fibular graft
The operation proceeded like this:
- The skin and subcutaneous tissue of the chin was incised in the mid-line by a head and neck surgeon. The tissue was then stripped from the part of the mandibular bone that was going to be removed.
- The oral and maxillofacial surgeon fixed the patient’s jaw with steel wire so the bite would remain the same after the bone graft reconstruction.
- The mandible was then divided with an oscillating bone saw. Approximately 5 cm of bone was removed. Bone marrow samples from the remaining edges was sent for pathological analysis.
- When the bone was removed, the underlying tumor was resected.
- Meanwhile, the hand surgeons had started to work on the patient’s leg. His left calf was emptied of blood with a pressure bandage. The blood was kept out with a tourniquet, so the surgeons could work in a non-circulated environment. A 10 cm long segment of the fibula was cut out with an identified artery and vein. When the fibula segment is taken more than 20 cm from the ankle, this will in fact not affect the function of the patient’s leg at all!
- The oral and maxillofacial surgeon adapted the fibula segment to fit into the mandible. It was then fixed to the mandible using titanium plates and screws.
- Finally the hand surgeons anastomosed the graft vessels to vessels of the neck. The artery was anastomosed with the superior thyroid artery and the vein with the facial vein.
- The operation was finished by closing the wounds in the leg and the chin.
If there was no complications with the blood circulation of the graft, the patient would have a fully functional jaw and would not have any problems with the divided calf bone.
Watch my video of the operation here. Commentary in Norwegian, but if you’ve read this post you’ll hopefully be able to follow the procedure.