DOI QR코드

DOI QR Code

Vascularized bone grafts for post-traumatic defects in the upper extremity

  • Petrella, Giovanna (Department of Hand Surgery and Microsurgery, University Hospital Policlinico of Modena) ;
  • Tosi, Daniele (Department of Hand Surgery and Microsurgery, University Hospital Policlinico of Modena) ;
  • Pantaleoni, Filippo (Department of Hand Surgery and Microsurgery, University Hospital Policlinico of Modena) ;
  • Adani, Roberto (Department of Hand Surgery and Microsurgery, University Hospital Policlinico of Modena)
  • Received : 2020.05.19
  • Accepted : 2020.09.29
  • Published : 2021.01.15

Abstract

Vascularized bone grafts (VBGs) are widely employed to reconstruct upper extremity bone defects. Conventional bone grafting is generally used to treat defects smaller than 5-6 cm, when tissue vascularization is adequate and there is no infection risk. Vascularized fibular grafts (VFGs) are mainly used in the humerus, radius or ulna in cases of persistent non-union where traditional bone grafting has failed or for bone defects larger than 6 cm. Furthermore, VFGs are considered to be the standard treatment for large bone defects located in the radius, ulna and humerus and enable the reconstruction of soft-tissue loss, as VFGs can be harvested as osteocutaneous flaps. VBGs enable one-stage surgical reconstruction and are highly infection-resistant because of their autonomous vascularization. A vascularized medial femoral condyle (VFMC) free flap can be used to treat small defects and non-unions in the upper extremity. Relative contraindications to these procedures are diabetes, immunosuppression, chronic infections, alcohol, tobacco, drug abuse and obesity. The aim of our study was to illustrate the use of VFGs to treat large post-traumatic bone defects and osteomyelitis located in the upper extremity. Moreover, the use of VFMC autografts is presented.

Keywords

References

  1. Klifto CS, Gandi SD, Sapienza A. Bone graft options in upper-extremity surgery. J Hand Surg Am 2018;43:755-61. https://doi.org/10.1016/j.jhsa.2018.03.055
  2. Khan SN, Cammisa FP Jr, Sandhu HS, et al. The biology of bone grafting. J Am Acad Orthop Surg 2005;13:77-86. https://doi.org/10.5435/00124635-200501000-00010
  3. Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft: a clinical extension of microvascular techniques. Plast Reconstr Surg 1975;55:533-44. https://doi.org/10.1097/00006534-197505000-00002
  4. Adani R, Delcroix L, Innocenti M, et al. Reconstruction of large posttraumatic skeletal defects of the forearm by vascularized free fibular graft. Microsurgery 2004;24:423-9. https://doi.org/10.1002/micr.20067
  5. Safoury Y. Free vascularized fibula for the treatment of traumatic bone defects and nonunion of the forearm bones. J Hand Surg Br 2005;30:67-72. https://doi.org/10.1016/J.JHSB.2004.09.007
  6. Adani R, Delcroix L, Tarallo L, et al. Reconstruction of post-traumatic bone defects of the humerus with vascularized fibular graft. J Shoulder Elbow Surg 2008;17:578-84. https://doi.org/10.1016/j.jse.2007.12.011
  7. Chhabra AB, Golish SR, Pannunzio ME, et al. Treatment of chronic nonunions of the humerus with free vascularized fibula transfer: a report of thirteen cases. J Reconstr Microsurg 2009;25:117-24. https://doi.org/10.1055/s-0028-1090624
  8. Noaman HH. Management of upper limb bone defects using free vascularized osteoseptocutaneous fibular bone graft. Ann Plast Surg 2013;71:503-9. https://doi.org/10.1097/SAP.0b013e3182a1aff0
  9. Sakai K, Doi K, Kawai S. Free vascularized thin corticoperiosteal graft. Plast Reconstr Surg 1991;87:290-8. https://doi.org/10.1097/00006534-199102000-00011
  10. Burger HK, Windhofer C, Gaggl AJ, et al. Vascularized medial femoral trochlea osteocartilaginous flap reconstruction of proximal pole scaphoid nonunions. J Hand Surg Am 2013;38:690-700.
  11. Toros T, Ozaksar K. Reconstruction of traumatic tubular bone defects using vascularized fibular graft. Injury 2019 Aug 14 [Epub]. https://doi.org/10.1016/j.injury.2019.08.013.
  12. Arai K, Toh S, Tsubo K, et al. Complications of vascularized fibula graft for reconstruction of long bones. Plast Reconstr Surg 2002;109:2301-6. https://doi.org/10.1097/00006534-200206000-00021
  13. Malizos KN, Fyllos A, Varytimidis S, et al. Tips to secure healing at the free vascularised fibular graft-to-host bone junction. Injury 2019;50 Suppl 5:S46-9. https://doi.org/10.1016/j.injury.2019.10.047
  14. Bakri K, Shin AY, Moran SL. The vascularized medial femoral corticoperiosteal flap for reconstruction of bony defects within the upper and lower extremities. Semin Plast Surg 2008;22:228-33. https://doi.org/10.1055/s-2008-1081405
  15. Kakar S, Duymaz A, Steinmann S, et al. Vascularized medial femoral condyle corticoperiosteal flaps for the treatment of recalcitrant humeral nonunions. Microsurgery 2011;31:85-92. https://doi.org/10.1002/micr.20843
  16. Rodriguez-Vegas JM, Delgado-Serrano PJ. Corticoperiosteal flap in the treatment of nonunions and small bone gaps: technical details and expanding possibilities. J Plast Reconstr Aesthet Surg 2011;64:515-27. https://doi.org/10.1016/j.bjps.2010.06.035
  17. Choudry UH, Bakri K, Moran SL, et al. The vascularized medial femoral condyle periosteal bone flap for the treatment of recalcitrant bony nonunions. Ann Plast Surg 2008; 60:174-80. https://doi.org/10.1097/SAP.0b013e318056d6b5