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Büyüktopçu Ö, Baysal Ö, Ağırdil Y, Şahbat Y, Shammadli Z, Şirin E, Erol B. Midterm Donor Site Morbidity After Vascularized Free Fibula Flap Harvesting. Foot Ankle Int 2024; 45:364-372. [PMID: 38361397 DOI: 10.1177/10711007241226620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Vascularized fibula grafts (VFGs) have become one of the most preferred grafts for the reconstruction of bone defects. However, despite the many advantages over other graft options, recipient and donor site morbidities are also common. Donor site morbidity has been reported at rates ranging from 5% to 67%. The aim of this study was to present a single-center series examining the clinical, functional, and radiologic aspects of donor site morbidity following VFG harvesting. METHODS The study included 69 patients who underwent biological reconstruction with VFG for bone tumors, avascular necrosis of the femoral head, or bone defects after trauma. Patients were evaluated functionally, clinically, and radiologically for donor site morbidity. RESULTS Donor site morbidity was observed in 33 of 69 patients (48%). The most complications were sensation deficits around the feet and ankles (20 of 69; 29%). Knee laxity was more common in patients who underwent osteoarticular fibular resection (P = .006). CONCLUSION We found VFG to be an effective method for the reconstruction of large bone defects, but associated with a relatively high rate of complications. Complications requiring surgical intervention were rare and the majority of patients did not have long-term functional limitations. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Ömer Büyüktopçu
- Marmara University School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Özgür Baysal
- Marmara University School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Yücel Ağırdil
- Marmara University School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Yavuz Şahbat
- Erzurum Regional Training and Research Hospital, Department of Orthopaedics and Traumatology, Erzurum, Turkey
| | - Ziya Shammadli
- Marmara University School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Evrim Şirin
- Marmara University School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Bülent Erol
- Marmara University School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
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Hsiao WL, Wu YC, Tai HC. Reduced length of intensive care unit stay and early mechanical ventilator weaning with enhanced recovery after surgery (ERAS) in free fibula flap surgery. Sci Rep 2024; 14:302. [PMID: 38167861 PMCID: PMC10762210 DOI: 10.1038/s41598-023-50881-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024] Open
Abstract
This study aimed to evaluate the effects of the enhanced recovery after surgery (ERAS) program on postoperative recovery of patients who underwent free fibula flap surgery for mandibular reconstruction. This retrospective study included 188 patients who underwent free fibula flap surgery for complex mandibular and soft tissue defects between January 2011 and December 2022. We divided them into two groups: the ERAS group, consisting of 36 patients who were treated according to the ERAS program introduced from 2021 to 2022. Propensity score matching was used for the non-ERAS group, which comprised 36 cases selected from 152 patients between 2011 and 2020, based on age, sex, and smoking history. After propensity score matching, the ERAS and non-ERAS groups included 36 patients each. The primary outcome was the length of intensive care unit (ICU) stay; the secondary outcomes were flap complications, unplanned reoperation, 30-day readmission, postoperative ventilator use length, surgical site infections, incidence of delirium within ICU, lower-limb comorbidities, and morbidity parameters. There were no significant differences in the demographic characteristics of the patients. However, the ERAS group showed the lower length of intensive care unit stay (ERAS vs non-ERAS: 8.66 ± 3.90 days vs. 11.64 ± 5.42 days, P = 0.003) and post-operative ventilator use days (ERAS vs non-ERAS: 1.08 ± 0.28 days vs. 2.03 ± 1.05 days, P < 0.001). Other secondary outcomes were not significantly different between the two groups. Additionally, patients in the ERAS group had lower postoperative morbidity parameters, such as postoperative nausea, vomiting, urinary tract infections, and pulmonary complications (P = 0.042). The ERAS program could be beneficial and safe for patients undergoing free fibula flap surgery for mandibular reconstruction, thereby improving their recovery and not increasing flap complications and 30-day readmission.
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Affiliation(s)
- Wei-Ling Hsiao
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Cheng Wu
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Zhong-Shan South Road, Taipei, 10002, Taiwan
| | - Hao-Chih Tai
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Zhong-Shan South Road, Taipei, 10002, Taiwan.
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Grünberger NM, Klein A, Barandun M, Schaefer DJ, Krieg AH, Kaempfen A. Vascularized Growth Plate Transfer in Paediatric Ulna Non-Union: Operative Technique and Review of the Literature. J Clin Med 2023; 12:4981. [PMID: 37568383 PMCID: PMC10419363 DOI: 10.3390/jcm12154981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Congenital pseudarthrosis of forearm fractures is rare and is strongly associated with neurofibromatosis type 1 (NF1). Our case report illustrates the progression of a non-union of the ulna after minor trauma in a twelve-year-old boy, newly diagnosed with NF1, and presents the technique of microsurgical bone reconstruction, including the growth plate. More than seven years after the first operation, follow-up presents a favorable outcome with a pain-free patient and unrestricted function of the forearm after a secondary correction of the remaining radial bowing. This treatment is discussed with a comprehensive review of the current literature on ulnar congenital pseudarthrosis in PubMed and Google Scholar and free fibular growth plate transfer in PubMed and Google Scholar. Nine publications reporting on 20 cases of congenital ulnar non-unions were identified. With this reconstructive option, favorable outcomes were achieved in all cases with the union after primary surgery and complications requiring further surgeries in nine cases. The benefit of vascularized growth plate bone transfer in congenital ulna non-union seems to be significant compared to other therapies such as open reduction internal fixation (ORIF), non-vascularized bone grafts, or one-bone-forearms and beneficial when growth reconstruction is needed. Other techniques might be necessary to improve insufficient long-term results.
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Affiliation(s)
- Nisha M. Grünberger
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel University Hospital, University of Basel, 4001 Basel, Switzerland; (N.M.G.); (A.K.); (M.B.); (D.J.S.)
| | - Amelie Klein
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel University Hospital, University of Basel, 4001 Basel, Switzerland; (N.M.G.); (A.K.); (M.B.); (D.J.S.)
| | - Marina Barandun
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel University Hospital, University of Basel, 4001 Basel, Switzerland; (N.M.G.); (A.K.); (M.B.); (D.J.S.)
| | - Dirk J. Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel University Hospital, University of Basel, 4001 Basel, Switzerland; (N.M.G.); (A.K.); (M.B.); (D.J.S.)
| | - Andreas H. Krieg
- Paediatric Orthopaedic Department, University Children’s Hospital, 4031 Basel, Switzerland;
| | - Alexandre Kaempfen
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel University Hospital, University of Basel, 4001 Basel, Switzerland; (N.M.G.); (A.K.); (M.B.); (D.J.S.)
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Muacevic A, Adler JR. Traumatic Radius Pseudoarthrosis in Neurofibromatosis Type 1: All Treatment Options in One Patient. Cureus 2023; 15:e34024. [PMID: 36814736 PMCID: PMC9939850 DOI: 10.7759/cureus.34024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 01/22/2023] Open
Abstract
Although congenital pseudoarthrosis of the radius is a rare case, it has been reported many times in the literature in the past and it has been shown that it can be associated with neurofibromatosis type 1. However, traumatic radius pseudoarthrosis has never been reported before. In this case report, all treatment options were applied to the same patient over a four-year period and the results were reported. A two-year-old boy had a left radius diaphysis fracture after a simple fall, and bone union could not be achieved despite the application of cast immobilization, internal fixation grafting, and electrical stimulation in an external center. He was admitted to our hospital when he was six years old. A plain X-ray image and computed tomography scan showed that he had radius pseudoarthrosis and also he was diagnosed with neurofibromatosis type 1 on genetic analysis. The patient underwent wide resection of the segment with pseudoarthrosis and free vascularized fibula grafting. Bone union was achieved in the third postoperative month.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Vuillermin C, Canizares MF, Bauer AS, Miller PE, Goldfarb CA. Congenital Upper Limb Differences Registry (CoULD): Registry Inclusion Effect. J Hand Surg Am 2021; 46:515.e1-515.e11. [PMID: 33423846 DOI: 10.1016/j.jhsa.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/11/2020] [Accepted: 11/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To advance the understanding of the epidemiology and treatment outcomes of congenital upper limb differences, a multicenter registry for Congenital Upper Limb Differences (CoULD) was established. After 4 years of recruitment, we sought to examine whether the relative frequency of congenital conditions compares with prior cross-sectional research and how the data have matured over time by (1) comparing our registry population with previous studies in similar populations and (2) evaluating the change over time of relative frequencies of selected conditions within the CoULD registry cohort, specifically to investigate for registry inclusion effects. METHODS Data from the 2 founding centers in the CoULD registry were analyzed over a 4-year period. We compared patients included in the CoULD registry against 2 prior studies by matching each condition according to the Oberg-Manske-Tonkin classification system. The relative frequency of 4 representative conditions was calculated to evaluate change over time and to determine when the inception cohort effect diminished. RESULTS The CoULD cohort of 1,381 patients was found to have notable differences compared with a 1-year cross-sectional cohort from the U.S. Midwest and a Swedish birth registry. Each of these registries had differences from the CoULD population in prevalence for approximately 33% of the diagnosis categories. The CoULD registry identified and included more pathologies of late presentation and those that do not commonly require surgical care. Changes in relative frequencies of incident and prevalent conditions, the registry inclusion effect, occurred early and stabilized by the third year. CONCLUSIONS The CoULD registry captures a different relative frequency of conditions than prior studies in similar populations. The findings highlight the CoULD registry may be a more accurate representation of clinical practice in tertiary referral centers; however, it is important to note that there was a registry inclusion effect identified. CLINICAL RELEVANCE Inclusion criteria are an important consideration with any longitudinal data collection method and data should display stability prior to registry reporting.
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Affiliation(s)
- Carley Vuillermin
- Harvard Medical School, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA.
| | - Maria F Canizares
- Harvard Medical School, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Andrea S Bauer
- Harvard Medical School, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Patricia E Miller
- Harvard Medical School, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Charles A Goldfarb
- Washington University School of Medicine, Department of Orthopedic Surgery, St. Louis Children's Hospital, St. Louis, MO; Department of Orthopedic Surgery, Shriners Hospitals for Children-St. Louis, St. Louis, MO
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Sauerbier M, Maldonado AA, Hoffmann R, Kuz N. [Possible applications of free microsurgical fibula transplantation in the reconstruction of complex bone defects in the extremities: review of the literature and case series]. HANDCHIR MIKROCHIR P 2020; 52:505-517. [PMID: 32820485 DOI: 10.1055/a-1183-4532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Extensive osseous defects of the extremities following trauma and tumour resection represent a major challenge for plasticreconstructive surgical teams. Defect reconstruction by free microsurgical fibula transplantation has become a standard method but is associated with a considerable rate of complications. The aim of the present work is to provide an up-to-date overview of the various reconstruction methods and to report our personal experiences with free fibula transplantation in a case series. PATIENTS AND METHODS The literature search on the subject was performed on Pubmed and Web of Science, and a retrospective collection of data was conducted based on our own cases, including clinical and radiological data. RESULTS From 2007 to 2018, free fibula transplantation was performed in 11 patients under the guidance of the senior author (MS). The defects were a result of pseudarthrosis in four cases, osteitis in three, and a tumour in two cases. Two patientssustained a primary defect due to a high-energy trauma. In nine cases the upper limb was affected; only two had the defect in the lower limb. No graft failure was observed. In eight cases, an osteoseptocutaneous graft was taken; in two cases there was a post-operative loss of the skin island. Fibula length ranged between 5 and 22 cm. In all cases, bony integration of the graft was complete. The range of motion in the affected limb after physiotherapy was very good to satisfactory. CONCLUSION Extensive bone defect reconstruction using free fibula flaps is undoubtedly the gold standard method, but the high rate of complications described in the literature necessitates a strict indication in due consideration of possible alternatives. Close cooperation between the disciplines of plastic reconstructive surgery and trauma orthopaedics is indispensable.
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Affiliation(s)
- Michael Sauerbier
- PROFESSOR SAUERBIER, Privatärztliche Praxis für Hand- und Plastische Chirurgie, Bad Homburg v. d. Höhe
| | - Andres A Maldonado
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Abteilung für Plastische, Hand- und -Rekonstruktive Chirurgie
| | - Reinhard Hoffmann
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Unfallchirurgie und Orthopädische Chirurgie
| | - Nikolai Kuz
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Abteilung für Plastische, Hand- und -Rekonstruktive Chirurgie
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Mohseni AA, Boussetta R, Saied W, Zairi M, Msakni A, Bouchoucha S, Nessib MN. Congenital pseudarthrosis of the forearm treated with induced membrane technique: A case report. Int J Surg Case Rep 2020; 77:584-590. [PMID: 33395851 PMCID: PMC7708772 DOI: 10.1016/j.ijscr.2020.10.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/16/2022] Open
Abstract
Congenital pseudarthrosis of the forearm (CPF) is an uncommon entity frequently described in association with neurofibromatosis type 1. Surgical treatment Is required. This is a challenging pathology in pediatric orthopedic surgery due to the difficulty of achieving a satisfying result in terms of bone defect healing. Many techniques are described such us free vascularized fibula, illizarov and induced membrane. We describe a first case of the forearm non union associated with neurofibromatosis type 1 successfully treated with 2 steps of induced membrane. Whatever the technique selected it's remain challenging problem in pediatric orthopaedic.
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Affiliation(s)
- Ahmed Amine Mohseni
- Children's Hospital Béchir Hamza, Tunis Tunisia Pediatric Orthopedic Surgery Department, Tunisia.
| | - Rim Boussetta
- Children's Hospital Béchir Hamza, Tunis Tunisia Pediatric Orthopedic Surgery Department, Tunisia.
| | - Walid Saied
- Children's Hospital Béchir Hamza, Tunis Tunisia Pediatric Orthopedic Surgery Department, Tunisia.
| | - Mohamed Zairi
- Children's Hospital Béchir Hamza, Tunis Tunisia Pediatric Orthopedic Surgery Department, Tunisia.
| | - Ahmed Msakni
- Children's Hospital Béchir Hamza, Tunis Tunisia Pediatric Orthopedic Surgery Department, Tunisia.
| | - Sami Bouchoucha
- Children's Hospital Béchir Hamza, Tunis Tunisia Pediatric Orthopedic Surgery Department, Tunisia.
| | - Mohamed Nabil Nessib
- Children's Hospital Béchir Hamza, Tunis Tunisia Pediatric Orthopedic Surgery Department, Tunisia.
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Siebelt M, de Vos-Jakobs S, Koenrades N, van Nieuwenhoven CAV, Oostenbrink R, Bramer WM, Verhaar JAN, Bessems GJHJM, Kempink DRJ. Congenital Forearm Pseudarthrosis, a Systematic Review for a Treatment Algorithm on a Rare Condition. J Pediatr Orthop 2020; 40:e367-74. [PMID: 31206425 DOI: 10.1097/BPO.0000000000001417] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A congenital forearm pseudarthrosis is a rare condition and is strongly associated with neurofibromatosis type 1. Several surgical techniques are described in the literature, but the most optimal treatment strategy remains unclear. This systematic review aims to develop a treatment algorithm that may aid in clinical decision making. METHODS The PROSPERO registration number for this study was CRD42018099602 and adheres to the PRISMA guidelines for systematic reviews. Embase, MEDLINE, Cochrane Central, Web of Science, and Google Scholar databases were searched for published studies reporting on congenital forearm pseudarthrosis not related to other underlying pathologies like bacterial infection or fibrous dysplasia. Results were not restricted by date or study type, only English literature was allowed. Studies were assessed for quality using the critical appraisal checklist for case reports from the Joanna Briggs Institute. Patient characteristics, underlying disease, type of surgery, union rate, and functional outcome were extracted from included studies. RESULTS Of 829 studies identified, 47 were included in this review (17 case series and 30 case reports, a total of 84 cases). A one-bone forearm procedure showed highest union rates (92%), however, it results in loss of forearm rotation. Free vascularized fibula grafting showed high union rates (87%) and was related to good functional outcome of elbow flexion and forearm rotations. Other procedures showed disappointing outcomes. CONCLUSIONS Congenital forearm pseudarthrosis is best treated with a free vascularized fibula grafting, a one-bone forearm procedure should be used as a salvage procedure. Evidence extracted from the case reports was sufficient to generate a treatment algorithm to be used in clinical pediatric practice. LEVEL OF EVIDENCE Level IV-therapeutic.
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Solla F, Lemoine J, Musoff C, Bertoncelli C, Rampal V. Surgical treatment of congenital pseudarthrosis of the forearm: Review and quantitative analysis of individual patient data. Hand Surgery and Rehabilitation 2019; 38:233-241. [DOI: 10.1016/j.hansur.2019.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/14/2019] [Accepted: 06/08/2019] [Indexed: 10/26/2022]
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Abstract
BACKGROUND Pediatric limb reconstruction after resection of a malignant tumor presents specific challenges. Multiple surgical techniques have been used to treat these patients. This paper describes a staged surgical technique for the reconstruction of large distal femoral defects due to tumor resection in skeletally immature patients. METHODS Three pediatric patients with osteosarcoma of the distal femur underwent staged reconstruction. Neoadjuvant chemotherapy was followed by en bloc tumor resection and immediate reconstruction of the distal femoral defect with a vascularized free fibular autograft utilizing a unique A-frame construct combined with intramedullary nail fixation. The second stage was a planned gradual lengthening of the healed construct, over a custom-made magnetically driven expandable intramedullary nail. RESULTS All patients achieved bony union and satisfactory length with minimal complications. The patients all returned to full, unlimited physical activities. CONCLUSIONS The early results confirm that the described technique is a safe and reliable procedure for the reconstruction of large femoral defects in pediatric patients with osteosarcoma. LEVEL OF EVIDENCE Level IV-therapeutic.
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Barla M, Polirsztok E, Peltié E, Jouve JL, Legré R, Dautel G, Barbary S, Journeau P. Free vascularised fibular flap harvesting in children: An analysis of donor-site morbidity. Orthop Traumatol Surg Res 2017; 103:1109-1113. [PMID: 28578099 DOI: 10.1016/j.otsr.2017.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 04/12/2017] [Accepted: 05/04/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The free vascularised fibular flap (FVFF) is widely used to treat bone defects, although it must be harvested from a healthy site. The objective of this study was to assess clinical morbidity and radiological changes at the FVFF donor site in children. HYPOTHESIS Distal fibular stabilisation using a tibial strut decreases the prevalence of valgus ankle deformity. MATERIAL AND METHOD Thirty-one children managed at two centres between 1994 and 2014 were included. Mean age was 8.9 years (range, 2-14 years) and mean follow-up was 6.6 years (range, 2-21 years). Early and delayed complications were evaluated. RESULTS Of the 17 early complications, 82.4% resolved fully within 7 months. Valgus ankle deformity developed in 6 (19.4%) patients. Age-residual fibula index under 16 was not significantly associated with valgus ankle deformity, although the P-value was borderline (P<0.058). Residual distal fibula length did not predict valgus ankle deformity. Three techniques were used for fibular reconstruction: syndesmotic screw, tibial strut, and both. None of these techniques prevented the occurrence of valgus ankle deformity. DISCUSSION Clinical donor-site morbidity after FVFF harvesting, although noticeable, usually resolved promptly. Taken alone, an age-residual fibula index under 16 did not predict valgus ankle deformity. We recommend a distal tibio-fibular quadricortical syndesmotic screw or combined syndesmotic screw-tibial strut fixation to prevent valgus ankle deformity, which is common when a tibial strut is used alone. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- M Barla
- Service d'orthopédie et traumatologie infantile, hôpital d'enfants de Brabois, CHU de Nancy, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - E Polirsztok
- Service d'orthopédie et traumatologie infantile, hôpital d'enfants de Brabois, CHU de Nancy, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - E Peltié
- Service d'orthopédie pédiatrique, hôpital La Timone, CHU de Marseille, 13385 Marseille, France
| | - J-L Jouve
- Service d'orthopédie pédiatrique, hôpital La Timone, CHU de Marseille, 13385 Marseille, France
| | - R Legré
- Service de chirurgie plastique et reconstructrice, hôpital La Timone, CHU de Marseille, 13385 Marseille, France
| | - G Dautel
- Service d'orthopédie et traumatologie infantile, hôpital d'enfants de Brabois, CHU de Nancy, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - S Barbary
- Service d'orthopédie et traumatologie infantile, hôpital d'enfants de Brabois, CHU de Nancy, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - P Journeau
- Service d'orthopédie et traumatologie infantile, hôpital d'enfants de Brabois, CHU de Nancy, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France.
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Ding DY, LaMartina J, Tai C, Pandya NK. Congenital Pseudoarthrosis of the Distal Radius Treated With Physeal-Sparing Double-Barrel Vascularized Free Fibula Transfer: A Case Report. Hand (N Y) 2017; 12:NP140-NP144. [PMID: 28403653 PMCID: PMC5684949 DOI: 10.1177/1558944717702472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Neurofibromatosis type 1 is a hereditary disease that can lead to pseudoarthrosis of various long bones. Rarely, pseudoarthrosis affects the forearm, and to the best of our knowledge, this is the first reported case of pseudarthrosis of the distal radius treated by this unique method. METHODS We present a case of a 7-year-old male who underwent multiple operations to treat pseudoarthrosis of the distal radius. RESULTS After failed conservative and operative fixation augmented with autologous iliac crest bone grafting, the patient underwent a successful double-barrel vascularized free fibula graft while preserving the physis of the distal radius. CONCLUSION Double-barrel vascularized free fibula bone graft can be successfully used as the definitive treatment in refractory cases of distal forearm pseudarthrosis and we believe that our technique can be applied to all cases of pseudarthrosis in other patients with a similar presentation and lesion location.
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Affiliation(s)
- David Y. Ding
- The Permanente Medical Group, San Francisco, CA, USA,David Y. Ding, Department of Orthopaedic Surgery, The Permanente Medical Group, 1600 Owens Street, 2nd Floor, San Francisco, CA 94158, USA.
| | | | - Chau Tai
- UCSF Benioff Children’s Hospital Oakland, CA, USA
| | - Nirav K. Pandya
- University of California, San Francisco, USA,UCSF Benioff Children’s Hospital Oakland, CA, USA
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Sulaiman AR, Wan Z, Awang S, Che Ahmad A, Halim AS, Ahmad Mohd Zain R. Long-term effect on foot and ankle donor site following vascularized fibular graft resection in children. J Pediatr Orthop B 2015; 24:450-5. [PMID: 26049965 DOI: 10.1097/BPB.0000000000000197] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was carried out to evaluate the long-term effect on the donor side of the foot and ankle following vascularized fibular graft resection in children. Eight patients underwent resection of the fibula for the purpose of a vascularized fibular graft by a surgical team who practiced leaving at least 6 cm residual distal fibula. The age of these children at the time of surgery was between 3 and 12 years. They were reviewed between 3 and 12 years after surgery. Two patients who underwent resection of the middle shaft of the fibula at 3 and 5 years of age developed abnormal growth of the distal tibia, leading to ankle valgus. They were treated with growth modulation of the distal tibial physis and supramalleolar osteotomy with tibiofibular synostosis. Another patient who underwent the entire proximal fibula resection at the age of 6 years had developed hindfoot valgus because of weakness of the tibialis posterior muscle. He required talonavicular fusion and flexor hallucis to tibialis posterior muscle transfer. Patients operated at the age of older than 8 years neither had ankle nor hindfoot deformity. We concluded that resection of the middle shaft of the fibula for the purpose of a vascularized fibula graft, leaving a 6 cm distal fibular stump in children younger than 6 years old, may give rise to abnormal growth of the distal tibial physis, leading to valgus ankle. The entire proximal fibular resection for the similar purpose in a 6-year-old child may give rise to weakness of tibialis posterior and hindfoot valgus.
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