Reconstruction of residual mandibular defects by iliac crest bone graft in war-wounded Iraqi civilians, 2006–2011

Our aim was to assess the long-term results, complications, and factors associated with failure of mandibular reconstructions among wounded Iraqi civilians with mandibular defects. Success was measured by the quality of bony union, and assessed radiographically and by physical examination. Failures were defined as loss of most or all of the bone graft, or inability to control infection. During the 6-year period (2006–2011), 35 Iraqi patients (30 men and 5 women, mean age 33 years, range 15–57) had residual mandibular defects reconstructed by iliac crest bone grafts. The causes were bullets (n = 29), blasts (n = 3), and shrapnel (n = 3). The size of the defect was more than 5 cm in 19 cases. Along the mandible the defect was lateral (n = 14), central/lateral (n = 5), lateral/central/lateral in continuity (n = 6), and central in continuity (n = 10). The mean time from injury to operation was 548 days (range 45–3814). All but 2 patients had infected lesions on admission. Bony fixation was ensured by locking reconstruction plates (n = 27), non-locking reconstruction plates (n = 6), and miniplates (n = 2). Complications were associated with the reconstruction plate in 2 cases, and donor-site morbidity in 5. After a mean follow-up of 17 months (range 6–54), bony union was achieved in 28 (80%). The quality of the bone was adequate for dental implants in 23 cases (66%). Our results suggest that war-related mandibular defects can be reconstructed with non-vascularised bone grafts by multistage procedures with good results, provided that the soft tissues are in good condition, infection is controlled, and the method of fixation is appropriate. Further studies are needed to assess the role of vascularised free flaps in similar conditions.