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Windhofer CM, Higgins JP, Gaggl A, Bürger HP. Lateral Femoral Trochlea Osteochondral Flap Reconstruction of Proximal Pole Scaphoid Nonunions. J Hand Surg Am 2024; 49:610.e1-610.e9. [PMID: 36333244 DOI: 10.1016/j.jhsa.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/03/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE The medial femoral trochlea flap has been described as a method of scaphoid proximal pole nonunion reconstruction when the proximal pole is deemed nonsalvageable. The lateral femoral trochlea (LFT) is an alternative donor site providing a comparable vascularized convex osteochondral flap. We describe the technique and outcomes of our first 17 cases of LFT flap reconstruction of the proximal scaphoid pole with a minimum follow-up of 14 months. METHODS Seventeen of the first 24 patients who underwent LFT scaphoid reconstruction at 3 institutions were able to be contacted for clinical follow-up and chart reviews. We recorded patient age and sex, duration of nonunion, number of previous surgical procedures, details of surgical technique, achievement of osseous union, complications, additional postoperative procedures, preoperative and postoperative pain, and range of motion. Preoperative and postoperative scapholunate and radiolunate angles were analyzed on x-rays and achievement of osseous union on computerized tomography scans. RESULTS The average age of patients included was 35 years (range, 16-55 years). Follow-up data were recorded at an average of 33 months (range, 14-62 months). Ten patients had previous procedures (average, 1; range, 0-2). Median duration from trauma to LFT was 3.4 years (range, 8 months-12 years) among patients who had a recognized date of injury. Osseous healing was achieved in 16 of 17 patients and confirmed by computerized tomograpy scan. Twelve patients reported complete pain relief, while 5 reported partial pain relief. Final postoperative range of motion was 59°extension (range, 30°-85°) and 50° flexion (range, 10°-80°), which was comparable to preoperative values. Preoperative (59°) and postoperative (55°) scapholunate angles were similar to normal wrists. CONCLUSION Vascularized LFT flaps provide an alternative donor site for vascularized osteochondral reconstruction of proximal pole scaphoid nonunion. Rate of union, range of motion, and pain relief are similar to reported results with medial femoral trochlea flap reconstruction. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Christian M Windhofer
- Department Traumatology, AUVA Trauma Center Salzburg, Salzburg, Austria; Ludwig-Boltzmann-Institute for Experimental and Clinical Traumatology in AUVA Trauma Research Center, Vienna, Austria.
| | - James P Higgins
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Alexander Gaggl
- Department of Oral and Maxillofacial Surgery, General Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
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Bottini GB, Joos V, Steiner C, Zeman-Kuhnert K, Gaggl A. Advances in Microvascular Reconstruction of the Orbit and Beyond: Considerations and a Checklist for Decision-Making. J Clin Med 2024; 13:2899. [PMID: 38792440 PMCID: PMC11122336 DOI: 10.3390/jcm13102899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
This paper aims to discuss the microvascular reconstruction of the orbit and adjacent regions and to propose a checklist to aid the reconstructive surgeon in this challenging undertaking. The discussion is based on a literature review that includes 32 retrospective case series, 5 case reports published in the last 34 years in PubMed, and 3 textbook chapters. Additionally, it relies on the senior author's expertise, described in a case series, and two case reports published elsewhere. Classifications and treatment algorithms on microvascular orbit reconstruction generally disregard patient-related factors. A more holistic approach can be advantageous: patient-related factors, such as age, comorbidities, prognosis, previous interventions, radiotherapy, and the wish for maximal dental rehabilitation and a prosthetic eye, have the same importance as defect-related considerations and can inform the choice of a reconstructive option. In this manuscript, we examine defect- and patient-related factors and new technologies, provide a checklist, and examine future directions. The checklist is intended as a tool to aid in the decision-making process when reconstructing the orbital region with microvascular flaps.
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Affiliation(s)
- Gian Battista Bottini
- Department of Oral and Maxillofacial Surgery and Centre for Reconstructive Surgery, University Hospital of the Private Medical University Paracelsus, 5020 Salzburg, Austria; (G.B.B.); (C.S.); (K.Z.-K.)
| | - Veronika Joos
- Private Practice for Dentistry and Oral and Maxillofacial Surgery, 5026 Salzburg, Austria
| | - Christoph Steiner
- Department of Oral and Maxillofacial Surgery and Centre for Reconstructive Surgery, University Hospital of the Private Medical University Paracelsus, 5020 Salzburg, Austria; (G.B.B.); (C.S.); (K.Z.-K.)
| | - Katharina Zeman-Kuhnert
- Department of Oral and Maxillofacial Surgery and Centre for Reconstructive Surgery, University Hospital of the Private Medical University Paracelsus, 5020 Salzburg, Austria; (G.B.B.); (C.S.); (K.Z.-K.)
| | - Alexander Gaggl
- Department of Oral and Maxillofacial Surgery and Centre for Reconstructive Surgery, University Hospital of the Private Medical University Paracelsus, 5020 Salzburg, Austria; (G.B.B.); (C.S.); (K.Z.-K.)
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Castrisos G, Gonzalez Matheus I, Sparks D, Lowe M, Ward N, Sehu M, Wille ML, Phua Y, Medeiros Savi F, Hutmacher D, Wagels M. Regenerative matching axial vascularisation of absorbable 3D-printed scaffold for large bone defects: A first in human series. J Plast Reconstr Aesthet Surg 2022; 75:2108-2118. [PMID: 35370116 DOI: 10.1016/j.bjps.2022.02.057] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/10/2021] [Accepted: 02/22/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND We describe the first clinical series of a novel bone replacement technique based on regenerative matching axial vascularisation (RMAV). This was used in four cases: a tibial defect after treatment of osteomyelitis; a calvarial defect after trauma and failed titanium cranioplasty; a paediatric tibial defect after neoadjuvant chemotherapy and resection of Ewing sarcoma; and a paediatric mandibular deficiency resulting from congenital hemifacial microsomia. METHOD All patients underwent reconstruction with three-dimensional (3D)-printed medical-grade polycaprolactone and tricalcium phosphate (mPCL-TCP) scaffolds wrapped in vascularised free corticoperiosteal flaps. OUTCOME Functional volumes of load-sharing regenerate bone have formed in all cases after a moderate duration of follow-up. At 36 cm, case 1 remains the longest segment of load bearing bone ever successfully reconstructed. This technique offers an alternative to existing methods of large volume bone defect reconstruction that may be safe, reliable, and give predictable outcomes in challenging situations. It achieves this by using a bioresorbable scaffold to support and direct the growth of regenerate bone, driven by RMAV. CONCLUSION This technique may facilitate the reconstruction of bone defects previously thought unreconstructable, reduce the risk of long-term implant-related complications and achieve these outcomes in a hostile environment. These potential benefits must now be formally tested in prospective clinical trials.
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Affiliation(s)
- George Castrisos
- Department of Plastic Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Isabel Gonzalez Matheus
- Department of Plastic Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia; The Herston Biofabrication Institute, Herston; The University of Queensland, Australia; Southside Clinical Division, School of Medicine, University of Queensland, Woolloongabba, Australia; The Australian Centre for Complex Integrated Surgical Solutions, Woolloongabba , Australia.
| | - David Sparks
- Department of Plastic Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia; Faculty of Engineering, Queensland University of Technology, Kelvin Grove, Australia; Southside Clinical Division, School of Medicine, University of Queensland, Woolloongabba, Australia
| | - Martin Lowe
- Department of Orthopaedic Surgery, Princess Alexandra Hospital, Woolloongabba QLD, Australia
| | - Nicola Ward
- Department of Orthopaedic Surgery, Princess Alexandra Hospital, Woolloongabba QLD, Australia
| | - Marjoree Sehu
- Southside Clinical Division, School of Medicine, University of Queensland, Woolloongabba, Australia; Infection Management Services, Princess Alexandra Hospital, Woolloongabba QLD, Australia
| | - Marie-Luise Wille
- Queensland University of Technology Node ARC Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing, QLD, Australia; Queensland University of Technology, Institute of Health Biomedical Innovation, Australia
| | - Yun Phua
- Department of Plastic and Reconstructive Surgery, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Flavia Medeiros Savi
- Department of Plastic and Reconstructive Surgery, Queensland Children's Hospital, South Brisbane, QLD, Australia; Queensland University of Technology, Institute of Health Biomedical Innovation, Australia
| | - Dietmar Hutmacher
- Queensland University of Technology Node ARC Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing, QLD, Australia; Queensland University of Technology, Institute of Health Biomedical Innovation, Australia
| | - Michael Wagels
- Department of Plastic Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia; The Herston Biofabrication Institute, Herston; The University of Queensland, Australia; Southside Clinical Division, School of Medicine, University of Queensland, Woolloongabba, Australia; Department of Plastic and Reconstructive Surgery, Queensland Children's Hospital, South Brisbane, QLD, Australia; The Australian Centre for Complex Integrated Surgical Solutions, Woolloongabba , Australia
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Klarendić A, Dovšak T. Femur Fracture Following Medial Femoral Condyle Flap Harvest: A Case Report. OPEN ACCESS SURGERY 2021. [DOI: 10.2147/oas.s333899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Mehta MP, Butler BA, Lanier ST, Ko JH, Kadakia AR. Calcaneal Reconstruction With Femoral Head Allograft Vascularized by an Osteocutaneous Medial Femoral Condyle Flap: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00007. [PMID: 34648468 DOI: 10.2106/jbjs.cc.21.00188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 25-year-old man presented with a closed calcaneal fracture after a 6-storey fall, complicated by osteomyelitis from fixation attempts necessitating near-complete debridement of his calcaneal tuberosity. He underwent a successful single-stage calcaneal and soft-tissue reconstruction using a femoral head structural allograft vascularized with an osteocutaneous medial femoral condyle flap. At the 18-month follow-up, his limb is largely pain-free and functional, allowing ambulation and his combined allograft-vascularized bone reconstruction shows radiographic evidence of incorporation. CONCLUSION Calcaneal tuberosity reconstruction with a femoral head structural allograft and vascularized bone flap is a viable option for calcaneal tuberosity bone loss because of injury/infection.
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Affiliation(s)
- Manish P Mehta
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bennet A Butler
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Steven T Lanier
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jason H Ko
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anish R Kadakia
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Castillo-Vázquez FG, Palafox-Carral I, Romo-Rodríguez R, Limón-Muñoz M, Farías-Cisneros E. Surgical Solution for Total Carpectomy due to Destructive Wrist Pan-Osteomyelitis Using a Free Femoral Condyle Osteocutaneous Flap for Wrist Arthrodesis. J Hand Microsurg 2021; 14:100-106. [DOI: 10.1055/s-0041-1736083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractOsteomyelitis of the hand is rare, even more so in the carpal bones. Patients with rheumatoid arthritis (RA) have a higher infection rate overall, and up to a 14-fold increase in the incidence of septic arthritis of the hand. The destruction of immunologic barriers, such as cartilage and joint capsules, as well as the use of immunosuppressive medications will have an impact on the higher incidence of articular infections and osteomyelitis in these patients. Infection in these cases is often overlooked because of the similarity of presentation to an acute event of RA. When osteomyelitis is present, rapid and aggressive treatment should be given. Surgical debridement, lavage, and excision of necrotic bone is the best choice, followed by cemented antibiotic impregnated spacer to resolve the acute scenario. Vascularized bone grafts (VBG) can then be used for a definitive solution, as these have great biologic properties that increase the possibility of a good outcome. We hereby present a report of a wrist arthrodesis, using a free medial femoral condyle VBG for the treatment of destructive osteomyelitis of the carpal bones in a female patient with RA.
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Affiliation(s)
| | - Ignacio Palafox-Carral
- Orthopedic Surgery Resident, Department of Orthopedic Surgery, Hospital Español de México, Mexico City, Mexico
| | | | - Marisol Limón-Muñoz
- Anesthesiology Division, Department of Regional Anesthesiology, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra,” CDMX, Mexico
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Advancements in Reconstructive Surgery Broaden Opportunities for Salvage of the Injured Lower Extremity. Ann Plast Surg 2021; 84:238-245. [PMID: 31513085 DOI: 10.1097/sap.0000000000001977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Advancements in microsurgery have made lower extremity reconstruction possible even after major soft tissue loss or tibial nerve disruption. There is an ongoing paradigm shift in the indications for amputation versus salvage and in flap selection protocols for different areas of the lower extremity. Initial evaluation, patient selection, triage, and timing of reconstruction are essential factors that can influence functional and aesthetic outcomes. The emergence of perforator flaps and the application of new concepts such as free-style flaps, propeller perforator flaps, thinning of free flaps, and supermicrosurgery have provided reconstructive surgeons with many techniques to decrease donor-site morbidity and improve outcomes. This includes options for reconstruction on extremities with single or no adequate runoff vessels. We present a review of the major advancements in reconstructive surgery for salvage of the traumatic lower extremity.
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Yang K, Boehm L, Rivedal D, Yan JG, Matloub H. Vascularized Olecranon Bone Graft: An Anatomical Study and Novel Technique. J Hand Surg Am 2020; 45:157.e1-157.e6. [PMID: 31303364 DOI: 10.1016/j.jhsa.2019.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/27/2019] [Accepted: 05/10/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Autologous bone grafting is commonly used in reconstructive hand surgery. Various sources of nonvascularized autologous bone grafts have been described in the literature. However, in some situations, a vascularized bone graft may be needed. Popular vascularized bone grafts are taken from the distal radius, iliac crest, and medial femoral condyle. The purpose of this study was to examine the feasibility of harvesting a free vascularized bone flap from the proximal ulna. METHODS Latex was injected via the brachial artery to facilitate visualization of perforators in 10 cadaveric specimens. Dissections were performed of the olecranon; all periosteal perforators were noted, and their lengths and diameters recorded. Corticocancellous bone flaps with their supplying pedicles were harvested. Three additional fresh specimens were injected with india ink via the pedicles to demonstrate perfusion of the harvested bone flap. RESULTS Consistent vascular anatomy supplied the olecranon. A perforator from the posterior ulnar recurrent artery supplied the proximal ulna and olecranon, from which a vascularized bone flap can be harvested. Branches to the flexor carpi ulnaris muscle may allow chimeric flaps to be harvested. Average pedicle length was 5.8 cm and average pedicle diameter was 2.4 mm. India ink injection of the pedicles showed perfusion of the periosteum as well as intraosseous cancellous bone. CONCLUSIONS A vascularized olecranon free flap can be harvested based on the posterior ulnar recurrent artery. Vascular anatomy is consistent and flap harvest is simple and straightforward in all cadaveric specimens. CLINICAL RELEVANCE A vascularized olecranon free flap represents a potential new surgical option when vascular bone flap reconstruction is considered.
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Affiliation(s)
- Kai Yang
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Lucas Boehm
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - David Rivedal
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Ji-Geng Yan
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Hani Matloub
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI.
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Struckmann VF, Rusignuolo G, Harhaus L, Trinler U, Bickert B, Kneser U, Kremer T. Donor site morbidity of vascularized bone grafts from the medial femoral condyle for osseous revascularization. Microsurgery 2019; 40:104-109. [PMID: 31077458 DOI: 10.1002/micr.30468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 04/14/2019] [Accepted: 04/26/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Vascularized bone grafts from the medial femoral condyle (MFC) are used to gain surgical revascularization of osseous defects. To date objective data regarding the donor site morbidity are limited. This study aims to evaluate the donor site associated outcome after MFC flap harvest. PATIENTS AND METHODS From 2008 to 2016, 22 patients who underwent MFC bone flap harvest for osseous revascularization of 9 talus, 8 scaphoids, 2 metacarpals, 1 phalanx, 1 pilon tibiale, and 1 distal femur were included. Outcome analysis was performed for the whole cohort as well as for two subgroups (recipient site upper [group A] and lower extremity [group B]) by the lower extremity functional scale (LEFS), the OAK-score of the Swiss Orthopedic Society and the visual analog scale (VAS). Additionally, a 3D gait analysis was performed for four patients. RESULTS The mean flap size was 1 × 1 × 3 cm. No flap loss was observed. One minor surgical revision was performed due to donor site hematoma. Mean follow-up was 35.8 (12-98) months. Mean LEFS-score was 74.9 ± 9.5 (A: 74.3 ± 7.9; B: 75.6 ± 11.2, p > .05) and OAK-score was 92.8 ± 9.4 (A: 93.2 ± 5.8; B: 92.4 ± 12.3, p > .05). At follow-up examination, pain at rest was stated with 0.1 ± 0.2 (A: 0.1 ± 0.3; B 0 ± 0, p > .05) and with activity 0.6 ± 1.4 (A: 1.2 ± 1.8; B: 0 ± 0, p > .05) on VAS. The 3-D gait analysis showed normative walking patterns. CONCLUSION After MFC flap harvest knee function and gait pattern were almost unimpaired. Donor site morbidity can be considered as being of minor concern in the decision-making for this microvascular procedure.
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Affiliation(s)
- Victoria Franziska Struckmann
- BG Trauma Center Ludwigshafen, Department of Hand, Plastic und Reconstructive Surgery, Burn Care Center, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Giuseppe Rusignuolo
- BG Trauma Center Ludwigshafen, Department of Hand, Plastic und Reconstructive Surgery, Burn Care Center, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Leila Harhaus
- BG Trauma Center Ludwigshafen, Department of Hand, Plastic und Reconstructive Surgery, Burn Care Center, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Ursula Trinler
- BG Trauma Center Ludwigshafen, Laboratory for Clinical Movement Analysis, Ludwigshafen, Germany
| | - Berthold Bickert
- BG Trauma Center Ludwigshafen, Department of Hand, Plastic und Reconstructive Surgery, Burn Care Center, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Ulrich Kneser
- BG Trauma Center Ludwigshafen, Department of Hand, Plastic und Reconstructive Surgery, Burn Care Center, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Thomas Kremer
- BG Trauma Center Ludwigshafen, Department of Hand, Plastic und Reconstructive Surgery, Burn Care Center, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany.,Department of Plastic and Hand Surgery, Leipzig, Germany
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Medial femoral condyle free flap for head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2019; 27:130-135. [DOI: 10.1097/moo.0000000000000517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hong JP(J, Song S, Suh HSP. Supermicrosurgery: Principles and applications. J Surg Oncol 2018; 118:832-839. [DOI: 10.1002/jso.25243] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/23/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Joon Pio (Jp) Hong
- Department of Plastic SurgeryAsan Medical Center, University of Ulsan College of MedicineSeoul Korea
| | - Sinyoung Song
- Department of Plastic SurgeryAsan Medical Center, University of Ulsan College of MedicineSeoul Korea
| | - Hyun Suk Peter Suh
- Department of Plastic SurgeryAsan Medical Center, University of Ulsan College of MedicineSeoul Korea
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Feasibility of Bone Perfusion Evaluation in Cadavers Using Indocyanine Green Fluorescence Angiography. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1570. [PMID: 29263970 PMCID: PMC5732676 DOI: 10.1097/gox.0000000000001570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022]
Abstract
Supplemental Digital Content is available in the text. Bone perfusion evaluation methods in cadaver studies have yet to be established. The aim of this report was to introduce and validate the feasibility of indocyanine green (ICG) fluorescence angiography for evaluation of bone perfusion in the femoral medial condyle in cadavers. In 4 fresh nonembalmed cadavers (2 female), the descending genicular artery was dissected and carefully cannulated bilaterally. A 10 mL solution containing 5 mL ICG solution and 5 mL methylene blue solution was injected into the descending genicular artery. After the injection, the medial femoral condyle was cut with an oscillating saw. A photograph was taken of the cut ends of the bone. The cut ends of the bones were observed using a near-infrared camera. Images corresponding to the previously taken photographs of the cut ends were captured for comparative analysis. After injection of methylene blue and ICG, the blue dye could be seen in the periosteum in all specimens, but not inside the cortex or the cancellous region of the bone. When observed with ICG fluorescence angiography, however, the cancellous region was highlighted through small perforators penetrating the periosteum. Perfusion inside the medial femoral condyle in cadavers was confirmed using ICG fluorescence angiography. Our method can be especially beneficial in confirming the bone perfusion of a new bone flap based on a particular artery, both in cadavers as well as in patients, because ICG can be injected into specific arteries.
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