The dissertation presents a solution to a pressing scientific problem, which lies in improving the efficiency of mandibular defect reconstruction. This is achieved, in particular, through the combination of cortico-cancellous bone block autotransplantation from the iliac crest and transplantation of a free vascularized soft tissue flap from the anterolateral thigh to the defect site.
Modern medicine offers a wide range of methods for mandibular defect reconstruction, including the use of autografts, allografts, 3D printing for creating customized implants, as well as tissue engineering. However, despite this variety, none of these methods can fully address all the challenges faced by surgeons.
In Ukraine, since the onset of the Russo-Ukrainian war in 2014, and subsequently the full-scale invasion in 2022, the number of patients with highenergy facial and mandibular injuries has critically increased. This has made explosive and gunshot trauma the dominant cause of acquired defects and deformities of the facial skeleton in recent years. High-energy mandibular injuries not only result in bone defects but are also associated with significant soft tissue avulsion, leading to more pronounced deformities and significantly complicating the treatment and rehabilitation of this patient category.
Several surgical methods for mandibular reconstruction have been developed and are currently in use to restore mandibular integrity. Each approach has its advantages and limitations, which are thoroughly reviewed in the literature section of this dissertation. One of the most effective and advanced methods, endorsed by many leading experts in reconstructive maxillofacial surgery, is the use of vascularized bone grafts. Specifically, free flaps from the fibula (FFF), scapula (SFP), or deep circumflex iliac artery (DCIA) are considered first-line options due to their high efficiency and favorable outcomes, both anatomically and functionally. However, their application comes with several challenges, including increased surgical complexity, the need for specialized equipment and instruments, high donor site morbidity, and significant surgical risks. Additionally, in certain clinical scenarios—particularly high-energy combat-related injuries involving vessel damage, ligation, or combined injuries such as limb amputations—microsurgical reconstruction becomes unfeasible. These limitations emphasize the need for an individualized approach to each case.
The objective of this study was to enhance treatment outcomes for patients with post-traumatic and post-surgical mandibular defects and adjacent soft tissue deficiencies while reducing postoperative complications. This was achieved through the combined use of free bone grafting techniques and vascularized soft tissue flaps. To accomplish this, a structured research program was developed, consisting of three consecutive stages: (1) identifying key clinical, anatomical, and surgical risk factors leading to postoperative complications and failures in mandibular defect reconstruction of various etiologies using iliac crest bone autografts (ICBG), particularly defects caused by high-energy trauma; (2) analyzing reconstruction outcomes for facial skeletal defects, including mandibular defects resulting from combat trauma, using a combination of anterolateral thigh flaps (ALTF) and free bone grafting; (3) assessing volumetric and density changes in iliac crest bone autografts during the postoperative period, both when used independently and in combination with anterolateral thigh flaps.
These stages incorporated general clinical methods, radiological techniques (including multi-slice computed tomography—MSCT), biometric methods (radiodensitometry and volumetry), and statistical analysis techniques.
