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Vandewalle L, Mézel A, Canavese F, Hamel A, Béhal H, Duteille F. Comparison of limb reconstruction with vascularized fibula flap versus induced membrane technique in 54 pediatric cases over 16 years. J Plast Reconstr Aesthet Surg 2024; 95:75-86. [PMID: 38889589 DOI: 10.1016/j.bjps.2024.05.033] [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: 01/15/2024] [Revised: 05/01/2024] [Accepted: 05/24/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Children's bone loss of limbs represents a significant challenge for surgeons, especially given that children are growing individuals. In the pediatric population, we compared bone reconstruction using vascularized fibula flaps with the induced membrane technique. The primary purpose of this study was to evaluate the delay and quality of consolidation. METHODS Data from patients who underwent limb reconstruction using either the fibula flap or the induced membrane were retrospectively collected from files across two centers. Perioperative and long-term complications were documented, along with functional and aesthetic outcome. RESULTS Between 2004 and 2020, 31 children underwent limb reconstruction using a fibula flap, and 13 patients were treated using the induced membrane technique. The etiologies included 76% tumors, 20% congenital pseudarthroses, and 3.7% infections. The median size of the bone resection was 12.5 cm (range: 1.8 to 31 cm). The median time to consolidation after free fibula flap transfer was 10 months (range: 2 to 55 months) versus 7.5 months (range: 1 to 64 months) for the Masquelet technique (p = 0.54). Limb length inequality occurred in 52% of fibula cases and 39% of the induced membrane cases (p = 0.55). CONCLUSIONS Both of free fibula flap and the induced membrane technique are effective options for bone reconstructing long bones in children. These techniques yield good functional outcomes and have comparable consolidation times.
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Affiliation(s)
- Louise Vandewalle
- Jeanne de Flandre Hospital, CHU Lille, Pediatric Orthopedics Department, France.
| | - Aurélie Mézel
- Jeanne de Flandre Hospital, CHU Lille, Pediatric Orthopedics Department, France
| | - Federico Canavese
- Jeanne de Flandre Hospital, CHU Lille, Pediatric Orthopedics Department, France
| | - Antoine Hamel
- Hôpital Mère Enfant, CHU Nantes, Pediatric Orthopedics Department, France
| | - Hélène Béhal
- Department of Biostatistics, Univ. Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins, CHU Lille, Lille, France
| | - Franck Duteille
- Hôtel Dieu, CHU Nantes, Department of Plastic, Reconstructive and Aesthetic Surgery, France
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Liu Q, Long F, Zhang C, Liu Y, He H, Luo W. Biological reconstruction of bone defect after resection of malignant bone tumor by allograft: a single-center retrospective cohort study. World J Surg Oncol 2023; 21:234. [PMID: 37525160 PMCID: PMC10388483 DOI: 10.1186/s12957-023-03121-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Allograft reconstruction following the resection of malignant bone tumors is associated with high rates of complications and failures. This study aimed to evaluate the efficacy and current problems of allograft reconstruction techniques to optimize treatment strategies at our center. MATERIALS AND METHODS Thirty-eight cases (16 men and 22 women), who were diagnosed with malignant bone tumors and had undergone allograft reconstruction, were recruited. Allograft was fixed by intramedullary nail, single steel plate, double plate, and intramedullary nail combined plate in 2, 4, 17, and 15 cases, respectively. Allograft union, local recurrence, and complications were assessed with clinical and radiological tests. Tumor grade was assessed using the Enneking staging of malignant bone tumors. Functional prognosis was evaluated by the Musculoskeletal Tumor Society (MSTS) scoring system. RESULTS Intercalary and osteoarticular reconstructions were performed in 32 and 6 cases, respectively. Six patients underwent reoperation related to allograft complications, four patients had local recurrence, and three patients with allograft fracture underwent allograft removal. A total of eight host-donor junctions showed nonunion, including seven cases (18.4%) in diaphysis and one case (3.1%) in metaphysis (p < 0.01). Host rejection and secondary osteoarthritis occurred in nine and two cases, respectively. No deep infection and internal fixation device fracture occurred. The overall allograft survival rate was 81.6%. Postoperative MSTS score of patients with allograft survival was 26.8 ± 2.9, indicating a significant improvement as compared to their preoperative function. CONCLUSIONS Allograft represents an excellent choice for intercalary bone defects after malignant bone tumor resection. Robust internal fixation protection across the whole length of the allograft is an important prerequisite for the survival of the allograft, while multidimensional osteotomy, intramedullary cement reinforcement, and pedicled muscle flap transfer can effectively improve the survival rate and healing rate of the allograft.
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Affiliation(s)
- Qing Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87Th Xiangya Road, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, 410008, People's Republic of China
| | - Feng Long
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87Th Xiangya Road, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, 410008, People's Republic of China
| | - Can Zhang
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87Th Xiangya Road, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, 410008, People's Republic of China
| | - Yupeng Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87Th Xiangya Road, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, 410008, People's Republic of China
| | - Hongbo He
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87Th Xiangya Road, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, 410008, People's Republic of China
| | - Wei Luo
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87Th Xiangya Road, Changsha, 410008, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, 410008, People's Republic of China.
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Horch RE, Arkudas A. Special Issue "Plastic and Reconstructive Surgery in Personalized Medicine". J Pers Med 2023; 13:jpm13030569. [PMID: 36983750 PMCID: PMC10059863 DOI: 10.3390/jpm13030569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
With an ever-growing knowledge in various disciplines of medicine and with rapidly evolving new techniques and operative methods in plastic surgery, it is obvious that it becomes more and more difficult to keep up with all the developments in this field at any time [...].
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Affiliation(s)
- Raymund E Horch
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg FAU, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg FAU, Krankenhausstrasse 12, 91054 Erlangen, Germany
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Lu Y, Lai C, Lai P, Yu Y. Induced Membrane Technique for the Management of Segmental Femoral Defects: A Systematic Review and Meta-Analysis of Individual Participant Data. Orthop Surg 2022; 15:28-37. [PMID: 36444955 PMCID: PMC9837298 DOI: 10.1111/os.13604] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/20/2022] [Accepted: 10/30/2022] [Indexed: 12/02/2022] Open
Abstract
Several modifications of the induced membrane technique (IMT) have been reported, but there is no consensus regarding their results and prognosis. Moreover, most studies have focused on tibial defects; no meta-analysis of the treatment of femoral defects using the IMT has been reported. This systematic review and meta-analysis aimed to identify the potential risk factors of post-procedural complications following the treatment of segmental femoral defects using the IMT. A comprehensive search was performed on the Cochrane Library, EBSCO, EMBASE, Ovid, PubMed, Scopus, and Web of Science databases, using the keywords "femur," "Masquelet technique," and "induced membrane technique." Original articles composed in English, having accessible individual patient data, and reporting more than two cases of bony defect or nonunion of femur or more than five cases of any body part were included. Post-procedural bone graft infections, final union status, and union time after second-stage operation were analyzed. Fourteen reports, including 90 patients, were used in this study. External fixation in second-stage surgery had an odds ratio of 9.267 for post-procedural bone graft infection (p = 0.047). The odds ratio of post-procedural bone graft infection and age >65 years for final non-union status was 51.05 (p = 0.003) and 9.18 (p = 0.042). Shorter union time was related to impregnated antibiotics in the spacer (p = 0.005), transplanting all-autologous grafts (p = 0.042), and the application of intramedullary nails as the second-stage fixation method (p = 0.050). The IMT appears to be reasonable and reproducible for femoral segmental bone defects. Several preoperative and surgical factors may affect post-procedural complications and union time.
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Affiliation(s)
- Yi Lu
- Department of Orthopedic Surgery, Musculoskeletal Research CenterChang Gung Memorial Hospital and Chang Gung UniversityTao‐YuanTaiwan
| | - Chih‐Yang Lai
- Department of Orthopedic Surgery, Musculoskeletal Research CenterChang Gung Memorial Hospital and Chang Gung UniversityTao‐YuanTaiwan
| | - Po‐Ju Lai
- Department of Orthopedic Surgery, Musculoskeletal Research CenterChang Gung Memorial Hospital and Chang Gung UniversityTao‐YuanTaiwan
| | - Yi‐Hsun Yu
- Department of Orthopedic Surgery, Musculoskeletal Research CenterChang Gung Memorial Hospital and Chang Gung UniversityTao‐YuanTaiwan
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Masquelet technique in military practice: specificities and future directions for combat-related bone defect reconstruction. Mil Med Res 2022; 9:48. [PMID: 36050805 PMCID: PMC9438145 DOI: 10.1186/s40779-022-00411-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/15/2022] [Indexed: 11/28/2022] Open
Abstract
Because of its simplicity, reliability, and replicability, the Masquelet induced membrane technique (IMT) has become one of the preferred methods for critical bone defect reconstruction in extremities. Although it is now used worldwide, few studies have been published about IMT in military practice. Bone reconstruction is particularly challenging in this context of care due to extensive soft-tissue injury, early wound infection, and even delayed management in austere conditions. Based on our clinical expertise, recent research, and a literature analysis, this narrative review provides an overview of the IMT application to combat-related bone defects. It presents technical specificities and future developments aiming to optimize IMT outcomes, including for the management of massive multi-tissue defects or bone reconstruction performed in the field with limited resources.
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Crenn V, Quinette Y, Bouthors C, Missenard G, Viard B, Anract P, Boisgard S, Mascard E, Gouin F. Intercalary allograft reconstruction following femoral tumour resection: mid- and long-term results and benefits of adding a vascularised fibula autograft. World J Surg Oncol 2022; 20:195. [PMID: 35698130 PMCID: PMC9195446 DOI: 10.1186/s12957-022-02650-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Bone healing in femoral reconstructions using intercalary allografts can be compromised in a tumour context. There is also a high revision rate for non-union, infection, and fractures in this context. The advantages and disadvantages of an associated vascularised fibula graft (VFG) are still a matter of debate. Methods In a multicentre study, we retrospectively analysed 46 allograft reconstructions, operated on between 1984 and 2017, of which 18 were associated with a VFG (VFG+) and 28 without (VFG−), with a minimum follow-up of 2 years. We determined the cumulative probability of bone union as well as the mid- and long-term revision risks for both categories by Kaplan-Meier survival analysis and a multivariate Cox model. We also compared the MSTS scores. Results Significant differences in favour of VFG+ reconstruction were observed in the survival analyses for the probability of bone union (log-rank, p = 0.017) and in mid- and long-term revisions (log-rank, p = 0.032). No significant difference was observed for the MSTS, with a mean MSTS of 27.6 in our overall cohort (p = 0.060). The multivariate Cox model confirmed that VFG+ was the main positive factor for bone union, and it identified irradiated allografts as a major risk factor for the occurrence of mid- and long-term revisions. Conclusion Bone union was achieved earlier in both survival and Cox model analyses for the VFG+ group. It also reduced the mid- and long-term revision risk, except when an irradiated allograft was used. In case of a tumour, we thus recommend using VFG+ from a fresh-frozen allograft, as it appears to be a more reliable long-term option. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02650-x.
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Affiliation(s)
- Vincent Crenn
- Service de Chirurgie Orthopédique, CHU de Nantes, Place Alexis Ricordeau, 44000, Nantes, France. .,INSERM, UMR 1238, Phy-Os, Université de Nantes, Nantes, France.
| | - Yonis Quinette
- Service de Chirurgie Orthopédique, CHU de Nantes, Place Alexis Ricordeau, 44000, Nantes, France
| | - Charlie Bouthors
- Service de Chirurgie Orthopédique, APHP/CHU Kremlin-Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Gilles Missenard
- Service de Chirurgie Orthopédique, APHP/CHU Kremlin-Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Brice Viard
- Service de Chirurgie Orthopédique, APHP/CHU Kremlin-Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Philippe Anract
- Service de Chirurgie Orthopédique, AP-HP/Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Stéphane Boisgard
- Service de Chirurgie Orthopédique, CHU Gabriel Montpied, 58 rue Montalembert, 63000, Clermont-Ferrand, France
| | - Eric Mascard
- Département de Chirurgie Orthopédique Pédiatrique, APHP/Hôpital Necker, 149 rue de Sèvres, 75015, Paris, France
| | - François Gouin
- Service de Chirurgie Orthopédique, CHU de Nantes, Place Alexis Ricordeau, 44000, Nantes, France.,INSERM, UMR 1238, Phy-Os, Université de Nantes, Nantes, France.,Département de Chirurgie, Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France
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Deininger C, Wagner A, Heimel P, Salzer E, Vila XM, Weißenbacher N, Grillari J, Redl H, Wichlas F, Freude T, Tempfer H, Teuschl-Woller AH, Traweger A. Enhanced BMP-2-Mediated Bone Repair Using an Anisotropic Silk Fibroin Scaffold Coated with Bone-like Apatite. Int J Mol Sci 2021; 23:283. [PMID: 35008718 PMCID: PMC8745248 DOI: 10.3390/ijms23010283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/16/2022] Open
Abstract
The repair of large bone defects remains challenging and often requires graft material due to limited availability of autologous bone. In clinical settings, collagen sponges loaded with excessive amounts of bone morphogenetic protein 2 (rhBMP-2) are occasionally used for the treatment of bone non-unions, increasing the risk of adverse events. Therefore, strategies to reduce rhBMP-2 dosage are desirable. Silk scaffolds show great promise due to their favorable biocompatibility and their utility for various biofabrication methods. For this study, we generated silk scaffolds with axially aligned pores, which were subsequently treated with 10× simulated body fluid (SBF) to generate an apatitic calcium phosphate coating. Using a rat femoral critical sized defect model (CSD) we evaluated if the resulting scaffold allows the reduction of BMP-2 dosage to promote efficient bone repair by providing appropriate guidance cues. Highly porous, anisotropic silk scaffolds were produced, demonstrating good cytocompatibility in vitro and treatment with 10× SBF resulted in efficient surface coating. In vivo, the coated silk scaffolds loaded with a low dose of rhBMP-2 demonstrated significantly improved bone regeneration when compared to the unmineralized scaffold. Overall, our findings show that this simple and cost-efficient technique yields scaffolds that enhance rhBMP-2 mediated bone healing.
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Affiliation(s)
- Christian Deininger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (C.D.); (A.W.); (N.W.); (H.T.)
- Department of Orthopedics and Traumatology, Salzburg University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (F.W.); (T.F.)
| | - Andrea Wagner
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (C.D.); (A.W.); (N.W.); (H.T.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
| | - Patrick Heimel
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
- AUVA Research Centre, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, 1200 Vienna, Austria
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Elias Salzer
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
- Department Life Science Engineering, University of Applied Sciences Technikum Wien, 1200 Vienna, Austria
| | - Xavier Monforte Vila
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
- Department Life Science Engineering, University of Applied Sciences Technikum Wien, 1200 Vienna, Austria
| | - Nadja Weißenbacher
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (C.D.); (A.W.); (N.W.); (H.T.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
| | - Johannes Grillari
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
- AUVA Research Centre, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, 1200 Vienna, Austria
- Department of Biotechnology, Institute of Molecular Biotechnology, BOKU-University of Natural Resources and Life Sciences, 1180 Vienna, Austria
| | - Heinz Redl
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
- AUVA Research Centre, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, 1200 Vienna, Austria
| | - Florian Wichlas
- Department of Orthopedics and Traumatology, Salzburg University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (F.W.); (T.F.)
| | - Thomas Freude
- Department of Orthopedics and Traumatology, Salzburg University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (F.W.); (T.F.)
| | - Herbert Tempfer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (C.D.); (A.W.); (N.W.); (H.T.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
| | - Andreas Herbert Teuschl-Woller
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
- Department Life Science Engineering, University of Applied Sciences Technikum Wien, 1200 Vienna, Austria
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (C.D.); (A.W.); (N.W.); (H.T.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (P.H.); (E.S.); (X.M.V.); (J.G.); (H.R.)
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