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Driscoll CR, Davidson AL, Schuth O, Reynolds M. Fibular Allograft Osteoplasty and Silicone Arthroplasty following Gunshot Injury of the Metacarpal. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5369. [PMID: 37928638 PMCID: PMC10624454 DOI: 10.1097/gox.0000000000005369] [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: 04/21/2023] [Accepted: 09/14/2023] [Indexed: 11/07/2023]
Abstract
The complexity of a gunshot wound to the hand with segmental bone loss and adjacent joint disruption presents a unique challenge for the reconstructive surgeon. There are several options for posttraumatic reconstruction of hand joint defects, ranging from arthrodesis, implants, and autologous arthroplasty. Despite the abundance of literature regarding guidelines for isolated osteoplasty and arthroplasty, there are only case reports describing management of bone and joint defects, all within the setting of cancer resection. This case report presents a 24-year-old, right-hand dominant man with a gunshot wound to his left hand involving the fifth metacarpal and metacarpal phalangeal joint. The metacarpal was reconstructed with a fibular bone allograft with simultaneous placement of a silicone arthroplasty implant, allowing preservation of motion at the metacarpal phalangeal joint with satisfactory functional outcomes. This illustrates the feasibility of successfully reconstructing segmental bone loss and adjacent joint defects simultaneously in the traumatic setting of firearm injuries.
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Affiliation(s)
- Cassandra R. Driscoll
- From the Department of Plastic and Reconstructive Surgery, Wake Forest University, Winston-Salem, N.C
| | - Amelia L. Davidson
- From the Department of Plastic and Reconstructive Surgery, Wake Forest University, Winston-Salem, N.C
| | - Olga Schuth
- Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University, Richmond, Va
| | - Michael Reynolds
- From the Department of Plastic and Reconstructive Surgery, Wake Forest University, Winston-Salem, N.C
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2
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Abernathy L, Tocci SA, Scott RT. The Posttraumatic Tarsometatarsal Joints. Clin Podiatr Med Surg 2023; 40:581-592. [PMID: 37716738 DOI: 10.1016/j.cpm.2023.05.003] [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] [Indexed: 09/18/2023]
Abstract
Tarsometatarsal joint injuries can be painful and debilitating and are most commonly due to direct or indirect trauma. Posttraumatic arthritis is a well-known long-term complication, with incidence as high as 58%. Conservative treatment options include shoe modifications, orthotic inserts, topical or oral anti-inflammatories, and intra-articular corticosteroid injections. There are various joint prep and fixation techniques reported in the literature, many with positive clinical and radiographic outcomes. This article discusses nonoperative and operative management of posttraumatic tarsometatarsal joint arthritis, reviews available literature, and includes the authors' tips and techniques.
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Affiliation(s)
- Lant Abernathy
- The CORE Institute Advanced Foot and Ankle Reconstruction Fellowship, The CORE Institute, 9321 W Thomas Road Suite 205, Phoenix, AZ 85037, USA.
| | - Steven A Tocci
- The CORE Institute Advanced Foot and Ankle Reconstruction Fellowship, The CORE Institute, 9321 W Thomas Road Suite 205, Phoenix, AZ 85037, USA
| | - Ryan T Scott
- The CORE Institute Advanced Foot and Ankle Reconstruction Fellowship, The CORE Institute, 9321 W Thomas Road Suite 205, Phoenix, AZ 85037, USA
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3
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Fang J, Shi R, Qi W, Zheng D, Zhu H. Feasibility evaluation of the induced membrane technique with structural autologous strip bone graft management of phalangeal and metacarpal segmental defects using radiography. BMC Musculoskelet Disord 2023; 24:418. [PMID: 37231454 DOI: 10.1186/s12891-023-06519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
PURPOSE The purpose of this study was to explore the feasibility and evaluate the clinical outcomes of treatment for phalangeal and metacarpal segmental defects with the induced membrane technique and autologous structural bone grafting. METHODS Sixteen patients who sustained phalangeal or metacarpal bone segmental defects were treated by the induced membrane technique and autologous structural bone grafting from June 2020 to June 2021 at our center. RESULTS The average follow-up was 24 weeks (range, 12-40 weeks). Radiography demonstrated union of all bone grafts after an average of 8.6 weeks (range, 8-12 weeks). All incisions at donor and recipient sites demonstrated primary heal without infection complications. The mean visual analog scale score of the donor site was 1.8 (range, 0-5), with a good score in 13 cases and a fair score in 3. The mean total active motion of the fingers was 179.9°. CONCLUSIONS The feasibility of the induced membrane technique and structural treatment with a cylindrical bone graft for segmental bone defects of the metacarpal or phalanx is demonstrated by follow-up radiography results. The bone graft provided much more stability and structural support in the bone defects, and the bone healing time and bone union rate were ideal.
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Affiliation(s)
- Jie Fang
- Department of Hand Surgery, Clinical Anatomy Laboratory, Xuzhou Renci Hospital, Xuzhou, Jiangsu, 221004, Jiangsu, People's Republic of China.
| | - Rongjian Shi
- Department of Hand Surgery, Clinical Anatomy Laboratory, Xuzhou Renci Hospital, Xuzhou, Jiangsu, 221004, Jiangsu, People's Republic of China
| | - Weiya Qi
- Department of Hand Surgery, Clinical Anatomy Laboratory, Xuzhou Renci Hospital, Xuzhou, Jiangsu, 221004, Jiangsu, People's Republic of China
| | - Dawei Zheng
- Department of Hand Surgery, Clinical Anatomy Laboratory, Xuzhou Renci Hospital, Xuzhou, Jiangsu, 221004, Jiangsu, People's Republic of China
| | - Hui Zhu
- Department of Hand Surgery, Clinical Anatomy Laboratory, Xuzhou Renci Hospital, Xuzhou, Jiangsu, 221004, Jiangsu, People's Republic of China.
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4
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Application of 3D Printing in Bone Grafts. Cells 2023; 12:cells12060859. [PMID: 36980200 PMCID: PMC10047278 DOI: 10.3390/cells12060859] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/05/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
The application of 3D printing in bone grafts is gaining in importance and is becoming more and more popular. The choice of the method has a direct impact on the preparation of the patient for surgery, the probability of rejection of the transplant, and many other complications. The aim of the article is to discuss methods of bone grafting and to compare these methods. This review of literature is based on a selective literature search of the PubMed and Web of Science databases from 2001 to 2022 using the search terms “bone graft”, “bone transplant”, and “3D printing”. In addition, we also reviewed non-medical literature related to materials used for 3D printing. There are several methods of bone grafting, such as a demineralized bone matrix, cancellous allograft, nonvascular cortical allograft, osteoarticular allograft, osteochondral allograft, vascularized allograft, and an autogenic transplant using a bone substitute. Currently, autogenous grafting, which involves removing the patient’s bone from an area of low aesthetic importance, is referred to as the gold standard. 3D printing enables using a variety of materials. 3D technology is being applied to bone tissue engineering much more often. It allows for the treatment of bone defects thanks to the creation of a porous scaffold with adequate mechanical strength and favorable macro- and microstructures. Bone tissue engineering is an innovative approach that can be used to repair multiple bone defects in the process of transplantation. In this process, biomaterials are a very important factor in supporting regenerative cells and the regeneration of tissue. We have years of research ahead of us; however, it is certain that 3D printing is the future of transplant medicine.
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5
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Chappell AG, Ramsey MD, Dabestani PJ, Ko JH. Vascularized Bone Graft Reconstruction for Upper Extremity Defects: A Review. Arch Plast Surg 2023; 50:82-95. [PMID: 36755653 PMCID: PMC9902088 DOI: 10.1055/s-0042-1758639] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 08/04/2022] [Indexed: 02/09/2023] Open
Abstract
Upper extremity reconstruction may pose clinical challenges for surgeons due to the often-critical, complex functional demands of the damaged and/or missing structures. The advent of vascularized bone grafts (VBGs) has aided in reconstruction of upper extremity (UE) defects due to their superior regenerative properties compared with nonvascularized bone grafts, ability to reconstruct large bony defects, and multiple donor site options. VBGs may be pedicled or free transfers and have the potential for composite tissue transfers when bone and soft tissue are needed. This article provides a comprehensive up-to-date review of VBGs, the commonly reported donor sites, and their indications for the treatment of specific UE defects.
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Affiliation(s)
- Ava G. Chappell
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew D. Ramsey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Parinaz J. Dabestani
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Jason H. Ko
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Address for correspondence Jason H. Ko, MD, MBA, Associate Professor, Program Director Plastic Surgery Residency, Division of Plastic and Reconstructive SurgeryDepartment of Orthopedic Surgery, Northwestern University Feinberg School of MedicineChicago, IL 60611
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Xiao F, Shi J, Zhang X, Hu M, Chen K, Shen C, Chen X, Guo Y, Li Y. Gadolinium-doped whitlockite/chitosan composite scaffolds with osteogenic activity for bone defect treatment: In vitro and in vivo evaluations. Front Bioeng Biotechnol 2023; 11:1071692. [PMID: 36873374 PMCID: PMC9975562 DOI: 10.3389/fbioe.2023.1071692] [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: 10/16/2022] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
Reducing the incidence of bone defects caused by trauma and other primary diseases is an urgent task in modern society. In the present study, we developed a gadolinium-doped whitlockite/chitosan (Gd-WH/CS) scaffold and assessed its biocompatibility, osteoinductivity, and bone regeneration capacity for the treatment of calvarial defect in a Sprague-Dawley (SD) rat model. The Gd-WH/CS scaffolds possessed a macroporous structure, with a pore size ranging 200-300 μm, which facilitated the growth of bone precursor cells and tissues into scaffold. Results of cytological and histological biosafety experiments showed that both WH/CS and Gd-WH/CS scaffolds were non-cytotoxic to human adipose-derived stromal cells (hADSCs) and bone tissue, which demonstrated the excellent biocompatibility of Gd-WH/CS scaffolds. Results of western blotting and real-time PCR analysis provided a possible mechanism that Gd3+ ions in the Gd-WH/CS scaffolds promoted the osteogenic differentiation of hADSCs through the GSK3β/β-catenin signaling pathway and significantly upregulated the expression of osteogenic related genes (OCN, OSX and COL1A1). Finally, in animal experiments, SD rat cranial defects were effectively treated and repaired with Gd-WH/CS scaffolds due to its appropriate degradation rate and excellent osteogenic activity. This study suggests the potential utility of the Gd-WH/CS composite scaffolds in treating bone defect disease.
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Affiliation(s)
- Fei Xiao
- Department of Orthopedic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Jingjing Shi
- The Education Ministry Key Lab of Resource Chemistry and Shanghai Key Laboratory of Rare Earth Functional Materials, Shanghai Normal University, Shanghai, China
| | - Xinhai Zhang
- Department of Orthopedic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Min Hu
- The Education Ministry Key Lab of Resource Chemistry and Shanghai Key Laboratory of Rare Earth Functional Materials, Shanghai Normal University, Shanghai, China
| | - Kangming Chen
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Chao Shen
- Department of Orthopedic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Xiaodong Chen
- Department of Orthopedic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Yaping Guo
- The Education Ministry Key Lab of Resource Chemistry and Shanghai Key Laboratory of Rare Earth Functional Materials, Shanghai Normal University, Shanghai, China
| | - Yang Li
- Department of Orthopedic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai, China
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WINGE MI, RØKKUM M. Calcium phosphate bone cement and metaphyseal -corrective osteotomies in the upper extremity: long-term follow-up of 10 children. Acta Orthop 2022; 93:769-774. [PMID: 36161337 PMCID: PMC9511366 DOI: 10.2340/17453674.2022.4589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The evaluation of metaphyseal angular deformities in children includes indication and timing for corrective osteotomy, and possible need for several operations during growth. Gap-fillers are usually autologous bone grafts, which might cause donor site problems. Calcium phosphate (CaP) bone cement may be a possible alternative. PATIENTS AND METHODS We performed 15 corrective osteotomies from 2007 to 2013 in 10 children, ages 5 to 18, with Norian SRS bone cement as a gap-filler, in the distal radius (12), proximal radius (1), and proximal humerus (2). Due to growth arrest and gradually increasing malalignments 3/10 children needed 1-3 additional corrections. Locking plates and screws were used except in 1 case at first surgery, aged 5 (K-wires). 2 children needed additional limb lengthening with external fixator. RESULTS All osteotomies healed. Postoperative radiographs and CT scans showed good alignment and gradual transformation of cement into bone. Remodeling was visible intraoperatively in patients needing multiple surgeries. Return to earlier osteotomy sites was unproblematic. No adverse events from using CaP cement were experienced. INTERPRETATION CaP cement is an alternative to bone grafts in upper extremity metaphyseal corrective osteotomies in children, and also when greater corrections are necessary or several surgeries indicated during the growth period.
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Affiliation(s)
- Mona I WINGE
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magne RØKKUM
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Uno T, Honma R, Takahara M, Satake H, Oishi R, Maruyama M, Takagi M. Combining Cylindrical Bone Graft and Headless Screw Fixation for Nonunion of the Medial Trochlea of the Elbow: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00036. [PMID: 36099502 DOI: 10.2106/jbjs.cc.22.00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 19-year-old handballer presented with elbow pain and nonunion of the medial trochlea of the elbow. He had undergone earlier surgery for an elbow injury at 6 years of age. Revision surgery for nonunion was performed using an extra-articular method combining cylindrical bone graft and headless screw fixation. Partial union was observed, and he resumed sports after 3 months, with his limb largely pain-free and functional. At the 21-month follow-up, bone healing was complete. CONCLUSIONS Combining cylindrical bone graft and headless screw fixation using the extra-articular technique is an option for managing nonunion of the medial trochlea of the elbow.
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Affiliation(s)
- Tomohiro Uno
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
- Department of Orthopaedic Surgery, Yoshioka Hospital, Tendo, Yamagata, Japan
| | - Ryusuke Honma
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Masatoshi Takahara
- Department of Orthopaedic Surgery, Izumi Orthopaedic Hospital, Sendai, Miyagi, Japan
| | - Hiroshi Satake
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Ryuta Oishi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Masahiro Maruyama
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
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9
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Migliorini F, La Padula G, Torsiello E, Spiezia F, Oliva F, Maffulli N. Strategies for large bone defect reconstruction after trauma, infections or tumour excision: a comprehensive review of the literature. Eur J Med Res 2021; 26:118. [PMID: 34600573 PMCID: PMC8487570 DOI: 10.1186/s40001-021-00593-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/20/2021] [Indexed: 12/16/2022] Open
Abstract
Large bone defects resulting from musculoskeletal tumours, infections, or trauma are often unable to heal spontaneously. The challenge for surgeons is to avoid amputation, and provide the best functional outcomes. Allograft, vascularized fibular or iliac graft, hybrid graft, extracorporeal devitalized autograft, distraction osteogenesis, induced-membrane technique, and segmental prostheses are the most common surgical strategies to manage large bone defects. Given its optimal osteogenesis, osteoinduction, osteoconduction, and histocompatibility properties, along with the lower the risk of immunological rejection, autologous graft represents the most common used strategy for reconstruction of bone defects. However, the choice of the best surgical technique is still debated, and no consensus has been reached. The present study investigated the current reconstructive strategies for large bone defect after trauma, infections, or tumour excision, discussed advantages and disadvantages of each technique, debated available techniques and materials, and evaluated complications and new perspectives.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Gerardo La Padula
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Ernesto Torsiello
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Filippo Spiezia
- Ospedale San Carlo Potenza, Via Potito Petrone, 85100, Potenza, Italy
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, England
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10
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Orman O, Eren F, Kara AD, Cesur C, Yıldırım C, Aysal BK. A different option in vascular bone grafts in the hand and wrist region: Use of a dorsoulnar artery-based osteo-fascio-cutaneous flap: A case series. Jt Dis Relat Surg 2021; 32:504-513. [PMID: 34145830 PMCID: PMC8343860 DOI: 10.52312/jdrs.2021.79298] [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: 10/09/2020] [Accepted: 02/01/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives
This study aims to describe our surgery technique and discuss patients treated through the dorsoulnar artery (DUA)-based technique of osseous and osteo-fascio-cutaneous vascularized ulnar bone grafting. Patients and methods
Between January 2011 and January 2015, six male patients (median age: 22.5 years; range, 20 to 24 years) who underwent surgery during which the technique of DUA ulnar bone graft was utilized. One patient with scaphoid nonunion, three patients with Kienböck’s disease, and two patients with a traumatic metacarpal defect were retrospectively evaluated. The joint range of motion (ROM), grip strength, Disabilities of the arm, shoulder and Hand (DASH) questionnaire score and Visual Analog Scale (VAS) score, and radiographies before and after surgery were examined. Scintigraphy was performed at 12 weeks postoperatively to monitor the viability of the bone graft. Results
All patients showed improvements in the ROM, grip strength, VAS, and DASH scores. According to the radiographic examination, bone union was achieved in all patients and the scintigraphy revealed that vascularization was detected in the bone tissue. Conclusion
The advantages of DUA-based vascularized bone graft are good bone quality and quantity and versatility due to its long pedicle. The osteo-fasio-cutaneous DUA flap seems to be effective in the treatment of traumatic metacarpal bone defects accompanied by skin loss. The DUA-based vascularized ulnar bone may be a source for scaphoid and lunate biological bone reconstruction.
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Affiliation(s)
- Osman Orman
- İstanbul Metin Sabancı Baltalimanı Kemik Hastalıkları Eğitim ve Araştırma Hastanesi, El Cerrahisi Kliniği, 3447 Sarıyer, İstanbul, Türkiye.
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11
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Vascularized bone grafts for post-traumatic defects in the upper extremity. Arch Plast Surg 2021; 48:84-90. [PMID: 33503750 PMCID: PMC7861969 DOI: 10.5999/aps.2020.00969] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/29/2020] [Indexed: 11/26/2022] Open
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.
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12
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Law RW, Langan TM, Consul DW, Steriovski J, Prissel MA, Hyer CF. Safety Profile Associated With Calcaneal Autograft Harvesting Using a Reaming Graft Harvester. Foot Ankle Int 2020; 41:1487-1492. [PMID: 32880191 DOI: 10.1177/1071100720945693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Foot and ankle surgery often requires bone healing, whether in elective arthrodesis or trauma. While primary bone healing is possible, the rate of nonunion in foot and ankle surgery remains variable. The addition of autogenous bone graft can allow for higher union rates by adding to the biology at the site of bone healing. Harvesting autogenous bone graft from the calcaneus for foot and ankle surgery can be done quickly and efficiently and allow for an adequate amount of graft. METHODS A retrospective chart and radiographic review was performed for 1438 patients at a single center between August 1, 2015, and December 15, 2018, who underwent calcaneal autograft harvesting using a power-driven reaming graft harvester. RESULTS In total, 966 patients were included and evaluated for the safety and complication rate associated with the procedure. Only 1 patient (0.1%) had a major complication, and there were 14 minor complications (1.4%). CONCLUSION The safety profile and low complication rate of this case series demonstrate that this simple and efficient calcaneal autograft harvest technique can be considered when a small to moderate amount of autogenous bone graft is required to augment bone healing. LEVEL OF EVIDENCE Therapeutic level IV, case series.
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Affiliation(s)
| | - Travis M Langan
- Orthopedic Foot and Ankle Center, Worthington, OH, USA.,Advanced Foot and Ankle Surgical Fellowship, Orthopedic Foot and Ankle Center, Worthington, OH, USA
| | | | | | - Mark A Prissel
- Orthopedic Foot and Ankle Center, Worthington, OH, USA.,Advanced Foot and Ankle Surgical Fellowship, Orthopedic Foot and Ankle Center, Worthington, OH, USA
| | - Christopher F Hyer
- Orthopedic Foot and Ankle Center, Worthington, OH, USA.,Advanced Foot and Ankle Surgical Fellowship, Orthopedic Foot and Ankle Center, Worthington, OH, USA
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13
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Sallent I, Capella-Monsonís H, Procter P, Bozo IY, Deev RV, Zubov D, Vasyliev R, Perale G, Pertici G, Baker J, Gingras P, Bayon Y, Zeugolis DI. The Few Who Made It: Commercially and Clinically Successful Innovative Bone Grafts. Front Bioeng Biotechnol 2020; 8:952. [PMID: 32984269 PMCID: PMC7490292 DOI: 10.3389/fbioe.2020.00952] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/23/2020] [Indexed: 12/11/2022] Open
Abstract
Bone reconstruction techniques are mainly based on the use of tissue grafts and artificial scaffolds. The former presents well-known limitations, such as restricted graft availability and donor site morbidity, while the latter commonly results in poor graft integration and fixation in the bone, which leads to the unbalanced distribution of loads, impaired bone formation, increased pain perception, and risk of fracture, ultimately leading to recurrent surgeries. In the past decade, research efforts have been focused on the development of innovative bone substitutes that not only provide immediate mechanical support, but also ensure appropriate graft anchoring by, for example, promoting de novo bone tissue formation. From the countless studies that aimed in this direction, only few have made the big jump from the benchtop to the bedside, whilst most have perished along the challenging path of clinical translation. Herein, we describe some clinically successful cases of bone device development, including biological glues, stem cell-seeded scaffolds, and gene-functionalized bone substitutes. We also discuss the ventures that these technologies went through, the hindrances they faced and the common grounds among them, which might have been key for their success. The ultimate objective of this perspective article is to highlight the important aspects of the clinical translation of an innovative idea in the field of bone grafting, with the aim of commercially and clinically informing new research approaches in the sector.
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Affiliation(s)
- Ignacio Sallent
- Regenerative, Modular & Developmental Engineering Laboratory, National University of Ireland Galway, Galway, Ireland
- Science Foundation Ireland Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway, Galway, Ireland
| | - Héctor Capella-Monsonís
- Regenerative, Modular & Developmental Engineering Laboratory, National University of Ireland Galway, Galway, Ireland
- Science Foundation Ireland Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway, Galway, Ireland
| | - Philip Procter
- Division of Applied Materials Science, Department of Engineering Sciences, Uppsala University, Uppsala, Sweden
- GPBio Ltd., Shannon, Ireland
| | - Ilia Y. Bozo
- Histograft LLC, Moscow, Russia
- Federal Medical Biophysical Center of FMBA of Russia, Moscow, Russia
| | - Roman V. Deev
- Histograft LLC, Moscow, Russia
- I.I. Mechnikov North-Western State Medical University, Saint Petersburg, Russia
| | - Dimitri Zubov
- State Institute of Genetic & Regenerative Medicine NAMSU, Kyiv, Ukraine
- Medical Company ilaya, Kyiv, Ukraine
| | - Roman Vasyliev
- State Institute of Genetic & Regenerative Medicine NAMSU, Kyiv, Ukraine
- Medical Company ilaya, Kyiv, Ukraine
| | | | | | - Justin Baker
- Viscus Biologics LLC, Cleveland, OH, United States
| | | | - Yves Bayon
- Sofradim Production, A Medtronic Company, Trévoux, France
| | - Dimitrios I. Zeugolis
- Regenerative, Modular & Developmental Engineering Laboratory, National University of Ireland Galway, Galway, Ireland
- Science Foundation Ireland Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway, Galway, Ireland
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14
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Raghuram A, Singh A, Chang DK, Nunez M, Reece EM. Bone Grafts, Bone Substitutes, and Orthobiologics: Applications in Plastic Surgery. Semin Plast Surg 2019; 33:190-199. [PMID: 31384235 DOI: 10.1055/s-0039-1693020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
As reconstructive needs often extend past the soft tissue alone, a plastic surgeon must also be well versed in the methods of bony reconstruction. Understanding of the basic science of fracture healing and the biochemical mechanisms of the different bone grafts, bone substitutes, and orthobiologics is essential to selecting among the many different options available to the modern plastic surgeon. This review provides a broad overview of these different options and the specific applications for plastic surgeons based on anatomic location.
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Affiliation(s)
| | - Aspinder Singh
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Daniel K Chang
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Mervin Nunez
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Edward M Reece
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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