Donor Site Morbidity of Nonvascularized Bone Graft: A Systematic Review


  • Lilies Dwi Sulistyani
  • Vera Julia
  • Teuku Zulfahmi Rizki
  • Dwi Kasta Dharmawan


Mandibular Reconstruction, Morbidity, Bone Transplantation, Ilium


Objective: To evaluate the donor site morbidity of iliac and fibular nonvascularized bone graft after mandibular resection. Material and Methods:This study was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in PubMed, Proquest, Science Direct, and Ebsco. A total of 12 studies met the criteria of studies in humans using iliac and fibular nonvascularized bone grafts in mandibular reconstruction after mandibular resection. Results: A greater proportion of patients received iliac nonvascularized bone graft (88.9%) than fibular nonvascularized bone graft (11.1%). Of the 385 cases of iliac bone graft, 153 cases (40%) experienced complications at the iliac donor site, whereas in 48 cases of fibular bone graft, two (4%) experienced complications at the donor site. Hemorrhage, bone fracture, infection requiring debridement, and hematoma were the major complications. Conclusion: The morbidity rate of the nonvascularized bone graft donor site of the fibula (4%) tended to be lower than that of the ilium (40%). Patient age and defect size were not significantly correlated with the occurrence of morbidity donor sites in either the ilium or fibula.


Silva L, Macedo R, Serpa M, Sobral A, Souza L. Global frequency of benign and malignant odontogenic tumors according to the 2005 WHO classification. J Oral Diag 2017; 2:1-8.

Pogrel M, Kahnberg K, Andersson L. Essentials of Oral and Maxillofacial Surgery. Chichester, United Kingdom: John Wiley & Sons; 2014.

Bonanthaya K, Panneerselvam E, Manuel S, Kumar V, Rai A. Oral and Maxillofacial Surgery for the Clinician. Singapore: Springer; 2021.

Osborn TM, Helal D, Mehra P. Iliac crest bone grafting for mandibular reconstruction: 10-year experience outcomes. J Oral Biol Craniofac Res 2018; 8(1):25-9.

Anand M, Panwar S. Commonly Utilized Non Vascularised Bone Grafts in Maxillofacial Reconstruction. In: Sun H. Surgical Management of Head and Neck Pathologies [Internet]. London: IntechOpen; 2021.

Ahmed W, Adil Asim M, Ehsan A, Abbas Q. Non-vascularized autogenous bone grafts for reconstruction of maxillofacial osseous defects. J Coll Phys Surg Pak 2018; 28(1):17-21.

Oryan A, Alidadi S, Moshiri A, Maffulli N. Bone regenerative medicine: classic options, novel strategies, and future directions. J Orthop Surg Res 2014; 9(1):18.

Agrawal A, Mehrotra D, Mohammad S, Singh RK, Kumar S, Pal US. Randomized control trial of non-vascularized fibular and iliac crest graft for mandibular reconstruction. J Oral Biol Craniofac Res 2012; 2(2):90-6.

Rana M, Warraich R, Kokemüller H, Lemound J, Essig H, Tavassol F, et al. Reconstruction of mandibular defects—clinical retrospective research over a 10-year period -. Head Neck Oncol 2011; 3(1):23.

Puricelli E, Chem RC. Thirty-eight-year follow-up of the first patient of mandibular reconstruction with free vascularized fibula flap. Head Face Med 2021; 17(1):46.

Sarukawa S, Noguchi T, Oh-Iwa I, Sunaga A, Uda H, Kusama M, et al. Bare bone graft with vascularised iliac crest for mandibular reconstruction. J Craniomaxillofac Surg 2012; 40(1):61-6.

Pang KM, Choi SW, Byun SH, Lee JY, Jung HJ, Lim KY, et al. Mandibular condylar-ramal reconstruction using vascularised costochondral graft based on the serratus anterior composite flap. J Craniomaxillofac Surg 2015; 43(7):1184-93.

Caldroney S, Ghazali N, Dyalram D, Lubek JE. Surgical resection and vascularized bone reconstruction in advanced stage medication-related osteonecrosis of the jaw. Int J Oral Maxillofac Surg 2017; 46(7):871-6.

Feuvrier D, Sagawa Y, Béliard S, Pauchot J, Decavel P. Long-term donor-site morbidity after vascularized free fibula flap harvesting: clinical and gait analysis. J Plast Reconstr Aesthet Surg 2016; 69(2):262-9.

Hadouiri N, Feuvrier D, Pauchot J, Decavel P, Sagawa Y. Donor site morbidity after vascularized fibula free flap: gait analysis during prolonged walk conditions. Int J Oral Maxillofac Surg 2018; 47(3):309-15.

Rendenbach C, Kohlmeier C, Suling A, Assaf AT, Catala-Lehnen P, Amling M, et al. Prospective biomechanical analysis of donor-site morbidity after fibula free flap. J Craniomaxillofac Surg 2016 ;44(2):155-9.

Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 2015; 162(11):777-84.

Gadre PK, Ramanojam S, Patankar A, Gadre KS. Nonvascularized bone grafting for mandibular reconstruction: myth or reality? J Craniofac Surg 2011; 22(5):1727-35.

ObimakindOkoje VN, Obimakinde OS, Arotiba JT, Fasola AO, Ogunlade SO, Obiechina AE. Mandibular defect reconstruction with nonvascularized iliac crest bone graft. Niger J Clin Pract 2012; 15(2):224-7.

Bai XF, Wushou A, Zheng J, Li G. An alternative approach for mandible reconstruction. J Craniofac Surg 2013; 24(2):e195-e198.

Magesh DP, Kumaravelu C, Maheshwari GU. Efficacy of PRP in the reconstruction of mandibular segmental defects using iliac bone grafts. J Maxillofac Oral Surg 2013; 12(2):160-7.

Scheerlinck LM, Muradin MS, van der Bilt A, Meijer GJ, Koole R, Van Cann EM. Donor site complications in bone grafting: comparison of iliac crest, calvarial, and mandibular ramus bone. Int J Oral Maxillofac Implants 2013; 28(1):222-7.

Akbay E, Aydogan F. Reconstruction of isolated mandibular bone defects with non-vascularized corticocancellous bone autograft and graft viability. Auris Nasus Larynx 2014; 41(1):56-62.

Ndukwe KC, Aregbesola SB, Ikem IC, Ugboko VI, Adebiyi KE, Fatusi OA, et al. Reconstruction of mandibular defects using nonvascularized autogenous bone graft in Nigerians. Niger J Surg 2014; 20(2):87-91.

Akinbami BO, Akadiri OA. Reconstruction of the mandible following benign tumor ablations: an audit of 20 cases. J Oral Maxillofac Surg Med Pathol 2015; 27(5):650-5.

Marechek A, AlShare A, Pack S, Demko C, Quereshy FA, Baur D. Nonvascularized bone grafts for reconstruction of segmental mandibular defects: is length of graft a factor of success? J Oral Maxillofac Surg 2019; 77(12):2557-66.

Sharma S, Hotkar S, Matne A, Vallabhaneni S, Ravipati A, Khandelwal A. Reconstruction of continuity defects of the mandible with non-vascularized bone grafts- Original study. Adv Med Dent Sci Research 2020; 8(11):23-6.

Allsopp BJ, Hunter-Smith DJ, Rozen WM. Vascularized versus nonvascularized Bone Grafts: what is the Evidence? Clin Orthop Relat Res 2016; 474(5):1319-27.

Kerrary S, Schouman T, Cox A, Bertolus C, Febrer G, Bertrand JC. Acute compartment syndrome following fibula flap harvest for mandibular reconstruction. J Craniomaxillofac Surg 2011; 39(3):206-8.

Fodor L, Dinu C, Fodor M, Ciuce C. Severe compartment syndrome following fibula harvesting for mandible reconstruction. Int J Oral Maxillofac Surg 2011; 40(4):443-5.

Brudnicki A, Rachwalski M, Wiepszowski Ł, Sawicka E. Secondary alveolar bone grafting in cleft lip and palate: a comparative analysis of donor site morbidity in different age groups. J Craniomaxillofac Surg 2019; 47(1):165-9.

Katz MS, Ooms M, Heitzer M, Peters F, Winnand P, Kniha K, et al. Postoperative morbidity and complications in elderly patients after harvesting of iliac crest bone grafts. Medicina 2021; 57(8):759.

Lonie S, Herle P, Paddle A, Pradhan N, Birch T, Shayan R. Mandibular reconstruction: meta-analysis of iliac- versus fibula-free flaps. ANZ J Surg 2016; 86(5):337-42.




How to Cite

Sulistyani, L. D., Julia, V., Rizki, T. Z., & Dharmawan, D. K. (2023). Donor Site Morbidity of Nonvascularized Bone Graft: A Systematic Review. Pesquisa Brasileira Em Odontopediatria E Clínica Integrada, 23, e220029. Retrieved from



Systematic Reviews (and Meta-Analysis)