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348
van Damme and Merkx
acceptor site, the type and amount of
bone needed, and the characteristics of
potential donor sites. When cancellous
bone can be used, e.g., for bridging gaps
in orthognathic surgery (patients 2, 6, 8,
and 9), trauma (patients 3 and 5), or
post-traumatic and oncologic recon­
structive surgery (patients 1, 4, and 7),
tibial grafts may be very suitable (Table
1). Particulate cancellous bone grafts do
not have the mechanical strength
desired for reconstruction of large
defects without additional support. On
the other hand, because of the large
open areas in these grafts, (re)vasculari­
zation usually takes place rapidly,
thereby bringing cellular regeneration,
remodeling, and gradual substitution
with new bone formation where old
bone has disappeared2,3,10,11,13.
The complication rates of tibial graft
harvesting are reported to range from
1.3% to 3.8%, which compares favorably with the complication rate of iliac
crest harvesting of 8.6-9.2%7,9. The
nine patients of this series do not allow
us to give a meaningful complication
rate, although a complication rate of 0%
is encouraging. The fact that the bone
grafts tend to be oily did not cause any
morbidity in the early follow-up period.
Because of possible growth-center
interference, the use of the tibia as do­
nor site is contraindicated in children
and adolescents. In questionable situa­
tions (e.g., an 18-year-old man), pre­
operative radiographs should be made
to verify closure of the epiphysial plates
and cessation of growth.
This modified graft harvesting tech­
nique is simple, is not time-consuming,
and produces reasonable amounts of
cancellous bone with a simple, handdriven instrument. Other techniques
need drilling equipment, tourniquets,
and osteotomes4,9,15, and may cause
weight-bearing limitations.
This modification allows weight
bearing immediately postoperatively,
needs neither a bloodless field nor
drainage, and does not appear to cause
complications or morbidity. The tibial
plateau can be considered a suitable do­
nor site for defined indications in bonegrafting procedures in oral and craniomaxillofacial surgery.
A cknow ledgm ents. We thank Dr A. C. Vian­
ds and D r E. N. R obertson for their linguistic
and editorial expertise, and Petra van Veelen
for typographic assistance.
References
1. B oyne PJ. U se of m arrow -cancellous
bone grafts in m axillary alveolar and
palatal clefts. I D ent R es 1974: 53: 8 2 1 4.
2. B u r c h a r d t H. The biology of bone graft
repair. Clin O rthop 1 9 8 3 : 174: 28-42,
3. B u r c h a r d t H . Biology of bone trans­
plantation. O rthop Clin North A m 1987:
18: 187-96.
4. C a t o n e GA, R e i m e r BL, M c N e ir D, R ay
R . Tibial autogenous cancellous bone as
an alternative donor site in maxillofacial
surgery: a prelim inary report. J Oral
M axillofac Surg 1992: 50: 1258-63.
5. F r e i h q f e r
H PM ,
B orstlap
WA,
K u i j p e r s - J a g t m a n AM , et al, Tim ing and
transplant m aterials for closure of alveo­
la r clefts, J C ranio-M ax-Fac Surg 1993:
21: 143-8.
6. H a b a l M B. D ifferent forms o f bone
grafts. In: H a b a l M B, R e d d i HA, eds.:
B one grafts and bone substitutes. Phila­
delphia: WB Saunders, 1992.
7. K l in e RM , W o l f e SA, C om plications
associated w ith the harvesting o f cranial
bone grafts. Plast R econstr Surg 1995:
95: 5 -1 3 .
8. M o w l e m R. Bone grafting. B r J Plast
Surg 1 9 6 3 : 16: 293-304.
9. O ’K e e f f e R M , R i e m e r BL, B u t t e r f i e l d
SL. H arvesting o f autogenous cancel­
lous bone graft from the proxim al tibial
m etaphysis: a review o f 230 cases. J O r­
thop Traum a 1991: 5: 4 6 9 -7 4 .
10. P e e r LA. The fate o f autogenous hum an
bone grafts. B r J Plast Surg 1950: 3:
233-43.
11. R o h r ic h RJ, M ic k e l TJ. Frontal sinus
obliteration: in search o f the ideal auto­
genous m aterial. Plast R econstr Surg
1995:95: 580-5.
12. S h e p a r d GH, D ie r b e r g W J. U se of the
cylinder osteotom e for cancellous bone
grafting. Plast R econstr Surg 1987: 80:
129-32.
13. S o l h e i m E, P in h o l t EM , T a l s n e s O,
L a r s e n TB, K ir k e b y OJ. Bone form a­
tion in cranial, m andibular, tibial and il­
iac bone grafts in rats. J C raniofac Surg
1995:6: 139-42.
14. T e s s ie r P. A utogenous bone grafts taken
from the calvarium for facial and cranial
applications. Clin Plast Surg 1982: 9:
531-8.
15. v a n S t r i j e n PJ, P e r d ij k FBT. De tibia als
donorplaats voor spongiosa. A bstractboek 37 e N ajaarsvergadering N ed Ver
M ondz Kaakchir, G roningen, 1993: 30.
16. W it s e n b u r g B. The reconstruction o f
anterior residual bone delects in patients
with cleft lip, alveolus and palate. J
M ax-F acS urg 1985: 13: 197-208.
Address:
Ph. A, van D am m e, MD, D M D
D epartm ent o f Oral and M axillofacial
Surgery
University H ospital N ijm egen
PO Box 9101
6500 H B N ijm egen
The N etherlands