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Gao Y, Liu Y, Hu H, Gao S, Zhou J. Tibial periosteum flap combined with autologous bone grafting in the treatment of Gustilo-IIIB/IIIC open tibial fractures. Open Med (Wars) 2024; 19:20241038. [PMID: 39308921 PMCID: PMC11416071 DOI: 10.1515/med-2024-1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 06/24/2024] [Accepted: 08/27/2024] [Indexed: 09/25/2024] Open
Abstract
Purpose Gustilo IIIB/C injuries are common for tibia diaphysis fractures with high rates of nonunion, osteomyelitis, and amputation. However, the managements on tibial Gustilo IIIB/C injuries are still controversial and individual. The aim of this study is to introduce the tibial periosteum flap combined with autologous bone grafting to treat Gustilo-IIIB/IIIC injuries. Methods Sixteen Gustilo type IIIB/C tibial fracture patients who underwent tibial periosteum flaps with autologous bone grafting surgeries were retrospectively studied. In the first stage, the wound was treated with debridement and the fracture was reduced and fixed with an external fixator. After covering with vacuum sealing drainage for 7 days, the wound areas were repaired by flaps. When the flaps survived and external fixators were removed, the tibial periosteum flaps were taken with autologous bone grafting for bone defects. Results The tibia fractures were comminuted fractures with mean size of segment bone defects 3.1 ± 1.3 cm. All the flaps survived and the wound healed in the first stage after an average of 1.5 ± 0.6 months. The mean size of the flap was 13.2 ± 2.8 cm × 7.3 ± 3.1 cm. All the autografts healed in 4.5 ± 0.7 months without infection and malunion. There was no pain in the affected limb. The weight-bearing and walking function were restored. Conclusion Tibial periosteum flap combined with autologous bone grafting is effective to treat bone-skin defect of leg with Gustilo-IIIB/IIIC injury.
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Affiliation(s)
- Yuling Gao
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yang Liu
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Hongyu Hu
- Department of Hand Surgery, The Second Hospital of Tangshan, Tangshan, Hebei, 063000, China
| | - Shunhong Gao
- Department of Hand Surgery, The Second Hospital of Tangshan, Jianshebei Road 21#, Tangshan, Hebei, 063000, China
| | - Junlin Zhou
- Beijing Chaoyang Hospital, Capital Medical University, Gongtinan Road 8#, Beijing, 100020, China
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Soldado F, Rivas-Nicolls D, Rojas-Neira J, Sevilla-Tirado JJ, Nguyen TQ, Knorr J. Vascularized Femoral Myo-Periosteal Graft for Congenital Pseudarthrosis of the Tibia: A Case Report. Microsurgery 2024; 44:e31218. [PMID: 39239787 DOI: 10.1002/micr.31218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 06/12/2024] [Accepted: 07/25/2024] [Indexed: 09/07/2024]
Abstract
Pure vascularized periosteal transplants have been shown to be extremely effective at achieving rapid bone healing in children with biologically complex non-union. Free tibial and fibular periosteal transplants are generally indicated when large periosteal flaps are necessary. We report using a vascularized femoral myo-periosteal graft (VFMPG) to treat distal tibial osteotomy non-union in a six-year-old boy with congenital pseudarthrosis of the tibia. The graft consisted of a 9 cm myo-periosteal flap (after 50% of elastic retraction) that incorporated the vastus intermedius muscle and diaphyseal femoral periosteum nourished by the descending branch of the lateral circumflex femoral vessels. Plantaris medialis was used as a recipient vessel. Healing occurred 10 weeks after surgery. The patient resumed gait and sports activity without orthosis. No donor or recipient site complications occurred 17 months after surgery. Employing a VFMPG might be an alternative to other free or large vascularized periosteal flaps currently in use for complex pediatric non-unions.
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Affiliation(s)
- Francisco Soldado
- Pediatric Hand Surgery and Microsurgery, Barcelona Children's Hospital, HM Nens, HM Hospitales, Barcelona, Spain
| | - Danilo Rivas-Nicolls
- Department of Plastic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Juliana Rojas-Neira
- Hand Surgery and Microsurgery Department, Pontificia Javeriana University Cali, Cali, Colombia
| | - Juan J Sevilla-Tirado
- Orthopedic Surgery Department, General Hospital of Defense Zaragoza, Zaragoza, Spain
| | | | - Jorge Knorr
- Pediatric Hand Surgery and Microsurgery, Barcelona Children's Hospital, HM Nens, HM Hospitales, Barcelona, Spain
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da Costa AC, Farina Brunelli JP, Rojas-Neira J, Falcochio DF, Sevilla-Tirado J, Soldado F. Reconstruction of congenital pseudarthrosis of the radius with a vascularized tibial periosteal transplant: A case report. Microsurgery 2024; 44:e31201. [PMID: 38886919 DOI: 10.1002/micr.31201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 04/04/2024] [Accepted: 05/16/2024] [Indexed: 06/20/2024]
Abstract
Congenital pseudarthrosis of the forearm poses a considerable challenge because of its rarity. The objective of this report is to introduce a novel surgical technique for its treatment. Here, we document a case of congenital pseudarthrosis of the radius in a 3-year-old boy diagnosed with type-1 neurofibromatosis. The surgical treatment involved the excision of approximately 9 cm of native radial periosteum and a bifocal radius osteotomy, which was supplemented with a vascularized tibial periosteal transplant to facilitate bone healing. Anastomosis between the anterior tibial vessels and radial vessels was performed. No immediate or late postoperative complications were observed. After 3 weeks, a robust callus formation was observed, and during a follow-up examination 3 years and 4 months later, a wide range of active forearm rotation was noted. This report suggests that vascularized periosteal flaps show promise as a viable treatment option for congenital pseudarthrosis of the forearm. They offer an alternative to vascularized fibular grafts or single-bone forearm constructs.
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Affiliation(s)
- Antonio Carlos da Costa
- Orthopaedic and Traumatology Surgery Department-Santa Casa de Sao Paulo, Hand Surgery and microsurgery Group, Sao Paulo, Brazil
| | - Joao Pedro Farina Brunelli
- Orthopaedic and Traumatology Surgery Department-Santa Casa de Sao Paulo, Hand Surgery and microsurgery Group, Sao Paulo, Brazil
| | - Juliana Rojas-Neira
- Hand Surgery and Microsurgery Department, Pontificia Javeriana University, Cali, Colombia
| | - Diego Figueira Falcochio
- Orthopaedic and Traumatology Surgery Department-Santa Casa de Sao Paulo, Hand Surgery and microsurgery Group, Sao Paulo, Brazil
| | - Juan Sevilla-Tirado
- Orthopedic Surgery Department, General Hospital of Defense Zaragoza, Zaragoza, Spain
| | - Francisco Soldado
- Pediatric Hand Surgery and Microsurgery, Barcelona Children's Hospital, HM Nens, HM Hospitales, Sao Paulo, Brazil
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Adeoye AO, Hadie SNH, Munajat I, Mohd Zaharri NI, Zawawi MSF, Tuan Sharif SE, Sulaiman AR. Periosteum: Functional Anatomy and Clinical Application. MALAYSIAN JOURNAL OF MEDICINE AND HEALTH SCIENCES 2023; 19:362-374. [DOI: 10.47836/mjmhs.19.3.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Periosteum is a connective tissue that envelopes the outer surface of bones and is tightly bound to the underlying bone by Sharpey’s fibers. It is composed of two layers, the outer fibrous layer and the inner cambium layer. The periosteum is densely vascularised and contains an osteoprogenitor niche that serves as a repository for bone-forming cells, which makes it an essential bone-regenerating tissue and has immensely contributed to fracture healing. Due to the high vascularity of inner cambium layer of the periosteum, periosteal transplantation has been widely used in the management of bone defects and fracture by orthopedic surgeons. Nevertheless, the use of periosteal graft in the management of bone defect is limited due to its contracted nature after being harvested. This review summarizes the current state of knowledge about the structure of periosteum, and how periosteal transplantation have been used in clinical practices, with special reference on its expansion.
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di Summa PG, Sapino G, Wagner D, Maruccia M, Guillier D, Burger H. Combined Free Flaps for Optimal Orthoplastic Lower Limb Reconstruction: A Retrospective Series. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050859. [PMID: 37241091 DOI: 10.3390/medicina59050859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/10/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Open fracture of the lower limb can lead to substantial bone and soft tissue damage, resulting in a challenging reconstructive scenarios, especially in presence of bone or periosteal loss, with a relevant risk of non-union. This work analyzes outcomes of using a double approach for orthoplastic reconstruction, adopting the free medial condyle flap to solve the bone defects, associated to a second free flap for specific soft tissue coverage. Indications, outcomes and reconstructive rationales are discussed. Materials and Methods: A retrospective investigation was performed on patients who underwent complex two-flap microsurgical reconstruction from January 2018 to January 2022. Inclusion criteria in this study were the use of a free femoral condyle periostal/bone flap together with a second skin-only flap. Only distal third lower limb reconstructions were included in order to help equalize our findings. Out of the total number of patients, only patients with complete pre- and post-operative follow-up (minimum 6 months) data were included in the study. Results: Seven patients were included in the study, with a total of 14 free flaps. The average age was 49. Among comorbidities, four patients were smokers and none suffered from diabetes. Etiology of the defect was acute trauma in four cases and septic non-union in three cases. No major complications occurred, and all flaps healed uneventfully with complete bone union. Conclusions: Combining a bone periosteal FMC to a second skin free flap for tailored defect coverage allowed achievement of bone union in all patients, despite the lack of initial bone vascularization or chronic infection. FMC is confirmed to be a versatile flap for small-to-medium bone defects, especially considering its use as a periosteal-only flap, with minimal donor site morbidity. Choosing a second flap for coverage allows for a higher inset freedom and tailored reconstruction, finally enhancing orthoplastic success.
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Affiliation(s)
- Pietro G di Summa
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland
| | - Gianluca Sapino
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland
| | - Daniel Wagner
- Department of Orthopedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland
| | - Michele Maruccia
- Department of Plastic Surgery and Reconstructive Surgery, University Hospital of Bari, 70100 Bari, Italy
| | - David Guillier
- Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery-University Hospital, 21231 Dijon, France
| | - Heinz Burger
- Privat Clinic Maria Hilf, 9010 Klagenfurt, Austria
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Lo S, Yonjan I, Rose A, Roditi G, Drury C, MacLean A. In search of the ideal periosteal flap for bone non-union: The chimeric fibula-periosteal flap. J Plast Reconstr Aesthet Surg 2023; 83:221-232. [PMID: 37285775 DOI: 10.1016/j.bjps.2023.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/13/2023] [Accepted: 04/07/2023] [Indexed: 06/09/2023]
Abstract
Vascularised periosteal flaps may increase the union rates in recalcitrant long bone non-union. The fibula-periosteal chimeric flap utilises the periosteum raised on an independent periosteal vessel. This allows the periosteum to be inset freely around the osteotomy site, thereby facilitating bone consolidation. PATIENTS AND METHODS Ten patients underwent fibula-periosteal chimeric flaps (2016-2022) at the Canniesburn Plastic Surgery Unit, UK. Preceding non-union 18.6 months, with mean bone gap of 7.5 cm. Patients underwent preoperative CT angiography to identify the periosteal branches. A case-control approach was used. Patients acted as their own controls, with one osteotomy covered by the chimeric periosteal flap and one without, although in two patients both the osteotomies were covered using a long periosteal flap. RESULTS A chimeric periosteal flap was used in 12 of the 20 osteotomy sites. Periosteal flap osteotomies had a primary union rate of 100% (11/11) versus those without flaps at 28.6% (2/7) (p = 0.0025). Union occurred in the chimeric periosteal flaps at 8.5 months versus 16.75 months in the control group (p = 0.023). One case was excluded from primary analysis due to recurrent mycetoma. The number needed to treat = 2, indicating that 2 patients would require a chimeric periosteal flap to avoid one non-union. Survival curves with a hazard ratio of 4.1 were observed, equating to a 4 times higher chance of union with periosteal flaps (log-rank p = 0.0016). CONCLUSIONS The chimeric fibula-periosteal flap may increase the consolidation rates in difficult cases of recalcitrant non-union. This elegant modification of the fibula flap uses periosteum that is normally discarded, and this adds to the accumulating data supporting the use of vascularised periosteal flaps in non-union.
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Affiliation(s)
- Steven Lo
- Canniesburn Regional Plastic Surgery and Burns Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, United Kingdom; School of Medicine, Dentistry and Nursing, University of Glasgow, G12 8QQ, United Kingdom.
| | - Indira Yonjan
- Canniesburn Regional Plastic Surgery and Burns Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, United Kingdom
| | - Anna Rose
- Canniesburn Regional Plastic Surgery and Burns Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, United Kingdom
| | - Giles Roditi
- Department of Radiology, Glasgow Royal Infirmary, Glasgow G4 0SF, United Kingdom
| | - Colin Drury
- Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow G4 0SF, United Kingdom
| | - Angus MacLean
- Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow G4 0SF, United Kingdom
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Siebert MJ, Makarewich CA. Anterolateral Tibial Bowing and Congenital Pseudoarthrosis of the Tibia: Current Concept Review and Future Directions. Curr Rev Musculoskelet Med 2022; 15:438-446. [PMID: 35841513 PMCID: PMC9789274 DOI: 10.1007/s12178-022-09779-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Congenital pseudarthrosis of the tibia (CPT) is a rare condition closely associated with neurofibromatosis type I. Affected children are born with anterolateral bowing of the tibia which progresses to pathologic fracture, pseudarthrosis, and high risk of refracture even after initial union has been attained. There is currently no consensus on the classification of this disease or consensus on its treatment. The purpose of this review is to (1) review the clinical presentation, etiology, epidemiology, classification, and natural history of congenital pseudarthrosis of the tibia and (2) review the existing trends in treatment of congenital pseudarthrosis of the tibia and its associated complications. RECENT FINDINGS Current treatment protocols focus primarily on combining intramedullary fixation with external or internal fixation to achieve union rates between 74 and 100%. Intramedullary devices should be retained as long as possible to prevent refracture. Cross-union techniques, though technically difficult, have a reported union rate of 100% and no refractures at mid- to long-term follow-up. Vascularized fibular grafting and induced membrane technique can be successful, but at the cost of numerous surgical procedures. Growth modulation is a promising new approach to preventing fracture altogether, though further study with larger patient series is necessary. The primary consideration in treatment of CPT is expected union rate and refracture risk. Combined intramedullary and external or internal fixation, especially with cross-union techniques, show most promise. Perhaps most exciting is further research on preventing fracture through guided growth, which may reduce the morbidity of multiple surgical procedures which have been the mainstay of treatment for CPT thus far.
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Affiliation(s)
- Matthew J Siebert
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Christopher A Makarewich
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
- Primary Children's Hospital, Salt Lake City, UT, USA.
- Shriners Children's, Salt Lake City, Utah, USA.
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Mayfield CK, Ayad M, Lechtholz-Zey E, Chen Y, Lieberman JR. 3D-Printing for Critical Sized Bone Defects: Current Concepts and Future Directions. Bioengineering (Basel) 2022; 9:680. [PMID: 36421080 PMCID: PMC9687148 DOI: 10.3390/bioengineering9110680] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2023] Open
Abstract
The management and definitive treatment of segmental bone defects in the setting of acute trauma, fracture non-union, revision joint arthroplasty, and tumor surgery are challenging clinical problems with no consistently satisfactory solution. Orthopaedic surgeons are developing novel strategies to treat these problems, including three-dimensional (3D) printing combined with growth factors and/or cells. This article reviews the current strategies for management of segmental bone loss in orthopaedic surgery, including graft selection, bone graft substitutes, and operative techniques. Furthermore, we highlight 3D printing as a technology that may serve a major role in the management of segmental defects. The optimization of a 3D-printed scaffold design through printing technique, material selection, and scaffold geometry, as well as biologic additives to enhance bone regeneration and incorporation could change the treatment paradigm for these difficult bone repair problems.
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Affiliation(s)
- Cory K. Mayfield
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
| | - Mina Ayad
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
| | - Elizabeth Lechtholz-Zey
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
| | - Yong Chen
- Department of Aerospace and Mechanical Engineering, Viterbi School of Engineering, University of Southern California, Los Angleles, CA 90089, USA
| | - Jay R. Lieberman
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
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Wang H, Wan J, Geng K, Zhang X, Hou R. Method for generating transparent porcine tibia showing the intraosseous artery. J Orthop Surg Res 2022; 17:408. [PMID: 36064419 PMCID: PMC9447338 DOI: 10.1186/s13018-022-03302-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background The occurrence of nonunion after tibial fracture surgery is mainly related to insufficient blood supply. Therefore, anatomical study of the internal and external tibial artery is very important, but there is no good method for displaying the intraosseous artery clearly and intuitively. This hinders the protection and reconstruction of it by surgeons, as well as the development of new instruments and techniques by researchers.
Objective To develop a transparent specimen that could clearly display the intraosseous artery of the tibia. Methods In 10 isolated pig calves with popliteal vessels, the popliteal artery was exposed and a tube was placed. A casting agent was then injected at constant pressure, and the tissue around the blood vessel was preliminarily removed after solidification. The perivascular tissue and periosteum were further removed via alkali corrosion, and the tibia was fixed with an external fixator to protect the non-corrosive areas at both ends. Alternate acid corrosion and flushing were then applied until the intraosseous artery was completely exposed. The distribution and branches of intraosseous nutrient arteries were observed with the naked eye and via microscopy. Three-dimensional (3D) scanning and 3D printing filling techniques were used to make transparent tibia specimens with preservation of intraosseous arteries. Results A cast specimen of the intraosseous artery of porcine tibia was successfully generated via epoxy resin perfusion combined with acid–alkali etching, and the intraosseous artery was clearly visible. The 3D printing and filling technique successfully produced a transparent tibia specimen with preservation of internal bone arteries, and accurately restored the external shape of the tibia. The foramen of the nutrient artery appeared near the middle upper third of the lateral edge of the tibia. After entering the tibia, the nutrient artery proceeded forward, medial, and downward for a certain distance, twisted and turned near the midpoint of the medullary cavity, and divided into the ascending and descending branches. After going in the opposite direction for a distance, the ascending trunk sent out 2–3 branches, and the descending trunk sent out 2–3 branches. Conclusion The cast specimen of pig intraosseous artery generated via the above-described perfusion corrosion method provides methodological guidance for the study of anatomical characteristics of the intraosseous artery, and a theoretical basis for the study of new methods of internal fixation and reconstruction of the blood supply of the lower tibia.
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Affiliation(s)
- Hongyu Wang
- Suzhou Medical College of Soochow University, Suzhou, China
| | - Jiaming Wan
- Teaching Hospital of the Medical College of Yangzhou University, Suzhou Ruihua Orthopedic Hospital, Yangzhou, China
| | - Kailong Geng
- Suzhou Medical College of Soochow University, Suzhou, China
| | | | - Ruixing Hou
- Teaching Hospital of the Medical College of Yangzhou University, Suzhou Ruihua Orthopedic Hospital, Yangzhou, China. .,Suzhou Ruihua Orthopedic Hospital, Suzhou, China.
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Catena N, Baldrighi C, Jester A, Soldado F, Farr S. Microsurgery in pediatric upper limb reconstructions: An overview. J Child Orthop 2022; 16:241-255. [PMID: 35992521 PMCID: PMC9382710 DOI: 10.1177/18632521221106390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/13/2022] [Indexed: 02/03/2023] Open
Abstract
The use of microsurgery has spread during the last decades, making resolvable many complex defects considered hitherto inapproachable. Although the small vessel diameter in children was initially considered a technical limitation, the increase in microsurgical expertise over the past three decades allowed us to manage many pediatric conditions by means of free tissue transfers. Pediatric microsurgery has been shown to be feasible, gaining a prominent place in the treatment of children affected by limb malformations, tumors, nerve injuries, and post-traumatic defects. The aim of this current concepts review is to describe the more frequent pediatric upper limb conditions in which the use of microsurgical reconstructions should be considered in the range of treatment options.
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Affiliation(s)
- Nunzio Catena
- Reconstructive Surgery and Hand Surgery
Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy,Nunzio Catena, Reconstructive Surgery and
Hand Surgery Unit, IRCCS Istituto Giannina Gaslini, Largo G. Gaslini 5, 16121
Genova, Italy.
| | - Carla Baldrighi
- Children’s Hand and Upper Limb Service,
Department of Plastic Surgery, Birmingham Children’s Hospital NHS Foundation Trust,
Birmingham, UK
| | - Andrea Jester
- Children’s Hand and Upper Limb Service,
Department of Plastic Surgery, Birmingham Children’s Hospital NHS Foundation Trust,
Birmingham, UK
| | - Francisco Soldado
- Pediatric Hand, Nerve and Microsurgery
Institute, Vall d’Hebron Instituto de Oncologia, Barcelona, Spain
| | - Sebastian Farr
- Pediatric Orthopedics and Foot and
Ankle Surgery, Orthopedic Hospital Speising, Vienna, Austria
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11
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Chen X, Yu B, Wang Z, Li Q, Dai C, Wei J. Progress of Periosteal Osteogenesis: The Prospect of In Vivo Bioreactor. Orthop Surg 2022; 14:1930-1939. [PMID: 35794789 PMCID: PMC9483074 DOI: 10.1111/os.13325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/25/2022] [Accepted: 05/14/2022] [Indexed: 12/14/2022] Open
Abstract
Repairing large segment bone defects is still a clinical challenge. Bone tissue prefabrication shows great translational potentials and has been gradually accepted clinically. Existing bone reconstruction strategies, including autologous periosteal graft, allogeneic periosteal transplantation, xenogeneic periosteal transplantation, and periosteal cell tissue engineering, are all clinically valuable treatments and have made significant progress in research. Herein, we reviewed the research progress of these techniques and briefly explained the relationship among in vivo microenvironment, mechanical force, and periosteum osteogenesis. Moreover, we also highlighted the importance of the critical role of periosteum in osteogenesis and explained current challenges and future perspective.
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Affiliation(s)
- Xiaoxue Chen
- Department of Plastic and Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, Shanghai, China
| | - Baofu Yu
- Department of Plastic and Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, Shanghai, China
| | - Zi Wang
- Department of Plastic and Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, Shanghai, China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, Shanghai, China
| | - Chuanchang Dai
- Department of Plastic and Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, Shanghai, China
| | - Jiao Wei
- Department of Plastic and Reconstructive Surgery, The Ninth Affiliated Hospital of Shanghai Jiaotong Medicine University, Shanghai, China
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12
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Soldado F, Barrera-Ochoa S, Romero-Larrauri P, Nguyen TQ, Diaz-Gallardo P, Guerra E, Knörr J. Congenital pseudarthrosis of the tibia: Rate of and time to bone union following contralateral vascularized periosteal tibial graft transplantation. Microsurgery 2022; 42:326-332. [PMID: 35137443 DOI: 10.1002/micr.30868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/05/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Congenital pseudarthrosis of the tibia (CPT) is one of the most challenging orthopedic disorders. The use of a vascularized tibial periosteal grafts has been recently reported as a powerful tool to obtain bone union. We report its use in CPT. PATIENTS AND METHODS Retrospective short-term study of 29 children (18 male/11 female, 15 right-sided/14 left-sided) of mean age 45 months (range 11-144 months), operated upon after October 2014. Nonunion site was debrided, and the periosteum of the involved limb was excised. A vascularized tibial periosteal graft (mean length 10.7 cm (range 9-15 cm) with a monitoring skin island (mean length 4.1 cm (range 3-5 cm) and based on the anterior tibial vessels, was obtained from the contralateral tibia. Anterior tibial vessels were always the recipient vessels. Most cases were stabilized with an LCP plate. The rate of and time to bone union were analyzed. Charts only were evaluated through the first 3 months after bone union was achieved. RESULTS The flap survived and bone union was obtained in all cases, through a periosteal callus, in a mean time of 5.1 weeks (range 3-6 weeks). Mean follow-up was 8.3 months (range 7-19 months). No union failures occurred 3 months after resuming unprotected weight bearing. CONCLUSIONS Our novel technique produced a consistent, rapid capacity for CPT union, superior to previously-reported techniques. However, it cannot be recommended as a standard method of treatment until consistent, long-term, refracture-free follow-up is documented.
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Affiliation(s)
- Francisco Soldado
- Pediatric Hand Surgery and MicrosurgeryBarcelona Children's Hospital, HM Nens, HM Hospitales, Barcelona, Spain
| | | | | | | | | | - Ernesto Guerra
- Complex Orthopedics Reconstruction Unit, Hospital Teknon, Barcelona, Spain
| | - Jorge Knörr
- Pediatric Hand Surgery and MicrosurgeryBarcelona Children's Hospital, HM Nens, HM Hospitales, Barcelona, Spain.,Pediatric Orthopedic Surgery Unit, Hospital Sant Pau, Barcelona, Spain
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Christen T, Krähenbühl SM, Müller CT, Durand S. Periosteal medial femoral condyle free flap for metacarpal nonunion. Microsurgery 2021; 42:226-230. [PMID: 34636060 PMCID: PMC9292408 DOI: 10.1002/micr.30826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/07/2021] [Accepted: 09/28/2021] [Indexed: 11/12/2022]
Abstract
Background Metacarpal nonunion is a rare condition. The osteogenic capacity of periosteal free flap was investigated in five patients with metacarpal nonunion and impaired bone vascularization. Patients and methods Surgery was performed between 64 and 499 days after the initial bone osteosynthesis. The average age was 27.6 (range 16–32) years. Nonunion was caused by excessive periosteal removal in two patients, extensive open trauma in three. Four nonunions were diaphyseal, one metaphyseal. A periosteal medial femoral condyle free flap was raised on the descending genicular artery for four patients, the superomedial genicular artery for one. After osteosynthesis with a plate, the flap was wrapped around the metacarpal, overlapping the bone proximally and distally. The recipient vessel were the dorsal branch of the radial artery and a vena comitans in the anatomical snuffbox in four patients, at the base of the first webspace in one. Results The flap size ranged from 5 × 3.5 cm to 8 × 4 cm. No postoperative complication occurred. Radiological bone union was achieved 3 to 8 months after surgery. One patient had a full range of motion, one a slight extension lag of the proximal interphalangeal joint, two moderate joint stiffness of the proximal interphalangeal or metacarpophalangeal joint (one requiring plate removal and extensor tenolysis), one severe stiffness that allowed using a hook grip which was the aim of the surgery. Conclusion In case of metacarpal nonunion with impaired bone vascularization, the periosteal medial femoral condyle free flap provides an effective and biomimetic approach to bone healing.
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Affiliation(s)
- Thierry Christen
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Swenn M Krähenbühl
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Camillo T Müller
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sébastien Durand
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Soldado F, Barrera-Ochoa S, Campillo-Recio D, Nguyen-Saint-Paul Q, Cherqaoui A, Knörr J. Free vascularized iliac periosteal graft for bilateral forearm nonunion reconstruction in a child with bilateral transfemoral amputation. Microsurgery 2021; 41:579-583. [PMID: 34228364 DOI: 10.1002/micr.30782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/21/2021] [Accepted: 06/25/2021] [Indexed: 11/09/2022]
Abstract
Vascularized periosteal flaps have been reported as very effective for treating biologically complex bone nonunion in pediatric patients, owing to their high angiogenic and osteogenic potentials. The purpose of this article is to report a case of a 6-year-old patient with nonunion involving both forearms and a very limited bone flap donor site in the context of prior bilateral transfemoral amputation due to meningococcal sepsis. Two free vascularized iliac periosteal flaps (VIPF), supplied by the deep circumflex iliac vessels, were used in two stages to reconstruct the forearms. In the first stage, the left forearm, which had a diaphyseal bone defect of 5 cm diameter in the ulna and 4 cm in the radius, was combined with an iliac-crest bone allograft, fixed with two longitudinal 1.8 mm Kirschner wires and surrounded with a free VIPF of 24 cm2 . Consolidation was achieved 3 months after left forearm surgery, while complete allograft revascularization and remodeling was observed at 12 months. In the second stage, the right forearm, which had a diaphyseal bone defect of 3 cm diameter in the ulna and 1 cm in the radius, was fixed the radius with a 2.7 mm plate and surrounded with a free VIPF of 24 cm2 . The radius nonunion healed 6 weeks after surgery. There were no postoperative complications. Two years postoperatively, the patient had again resumed his arm gait painlessly and without a splint. VIPF may be considered a valuable and reliable surgical option for nonunion reconstruction in complex clinical scenarios in children.
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Affiliation(s)
- Francisco Soldado
- Orthopedic Surgery, Barcelona University Childrens Hospital HM Nens, Barcelona, Spain.,Unidad UCA Mikel Sanchez, Vithas San José, Vitoria-Gasteiz, Spain
| | - Sergi Barrera-Ochoa
- icatMA Hand and Microsurgery Unit, ICATME, Hospital Universitari Quiron-Dexeus, Barcelona, Spain
| | - David Campillo-Recio
- icatMA Hand and Microsurgery Unit, ICATME, Hospital Universitari Quiron-Dexeus, Barcelona, Spain
| | | | - Abdelmounim Cherqaoui
- Service d'orthopédie Pédiatrique, Hôpital d'Enfants A. Harouchi, Université de Médecine Hassan 2, Casablanca, Morocco
| | - Jorge Knörr
- Orthopedic Surgery, Barcelona University Childrens Hospital HM Nens, Barcelona, Spain.,Unidad UCA Mikel Sanchez, Vithas San José, Vitoria-Gasteiz, Spain
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