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Guidi M, Guzzini M, Civitenga C, Lanzetti RM, Kim BS, Besmens IS, Riegger M, Lucchina S, Calcagni M, Perugia D. Multifactorial Analysis of Treatment of Long-Bone Nonunion with Vascularized and Nonvascularized Bone Grafts. J Hand Microsurg 2023; 15:106-115. [PMID: 37020609 PMCID: PMC10070005 DOI: 10.1055/s-0042-1748783] [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] [Indexed: 10/15/2022] Open
Abstract
Introduction The purpose of the study was to evaluate the results of treatment of the nonunion of long bones using nonvascularized iliac crest grafts (ICGs) or vascularized bone grafts (VBGs), such as medial femoral condyle corticoperiosteal flaps (MFCFs) and fibula flaps (FFs). Although some studies have examined the results of these techniques, there are no reports that compare these treatments and perform a multifactorial analysis. Methods The study retrospectively examined 28 patients comprising 9 women and 19 men with an average age of 49.8 years (range: 16-72 years) who were treated for nonunion of long bones between April 2007 and November 2018. The patients were divided into two cohorts: group A had 17 patients treated with VBGs (9 patients treated with MFCF and 8 with FF), while group B had 11 patients treated with ICG. The following parameters were analyzed: radiographic patterns of nonunion, trauma energy, fracture exposure, associated fractures, previous surgeries, diabetes, smoking, age, and donor-site morbidity. Results VBGs improved the healing rate (HR) by 9.42 times more than the nonvascularized grafts. Treatment with VBGs showed a 25% decrease in healing time. Diabetes increased the infection rate by 4.25 times. Upper limbs showed 70% lower infection rate. Smoking among VBG patients was associated with a 75% decrease in the HR, and diabetes was associated with an 80% decrease. Conclusion This study reports the highest success rates in VBGs. The MFCFs seem to allow better clinical and radiological outcomes with less donor-site morbidity than FFs.
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Affiliation(s)
- Marco Guidi
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Matteo Guzzini
- Department of Orthopedics and Traumatology, S. Andrea Hospital, University of Rome “La Sapienza,” Rome, Italy
| | - Carolina Civitenga
- Department of Orthopedics and Traumatology, S. Andrea Hospital, University of Rome “La Sapienza,” Rome, Italy
| | | | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Inga Swantje Besmens
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Martin Riegger
- Department of Orthopedics and Traumatology, Lugano's Regional Hospital, Viganello, Switzerland
| | - Stefano Lucchina
- Hand Surgery Unit, Locarno Hand Center, Locarno's Regional Hospital, Locarno, Switzerland
| | - Maurizio Calcagni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Dario Perugia
- Department of Orthopedics and Traumatology, S. Andrea Hospital, University of Rome “La Sapienza,” Rome, Italy
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Baek JH, Chung DW, Alhassan T, Lee JH. Wrist Reconstruction Using Free Vascularized Fibular Head Graft Following Intralesional Excision for Campanacci Grade 3 Giant Cell Tumors Involving the Articular Surface of the Distal Radius. J Hand Surg Am 2022; 47:1231.e1-1231.e6. [PMID: 34895778 DOI: 10.1016/j.jhsa.2021.09.036] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/31/2021] [Accepted: 09/30/2021] [Indexed: 02/02/2023]
Abstract
Reconstruction with a free vascularized fibular head graft after en bloc excision of a Campanacci grade 3 giant cell tumor of bone in the distal radius can effectively control local recurrence. However, it leads to the loss of wrist movement, subsequent radiocarpal subluxation, and an osteoarthritic change. Another treatment option for grade 3 lesions is intralesional excision and cementation, which preserves wrist movement but does not restore the articular surface. We report a case of wrist reconstruction using a free vascularized fibular head graft after the intralesional excision of a Campanacci grade 3 giant cell tumor of bone with invasion of the articular surface of the distal radius. In patients with this type of a lesion, wrist reconstruction using a free vascularized fibular head graft after intralesional excision can help prevent local tumor recurrence, restore the articular surface, and maintain movements of the wrist joint.
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Affiliation(s)
- Jong Hun Baek
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Duke Whan Chung
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Turki Alhassan
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Jae Hoon Lee
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, South Korea.
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Zekry KM, Yamamoto N, Hayashi K, Takeuchi A, Alkhooly AZA, Abd-Elfattah AS, Elsaid ANS, Ahmed AR, Tsuchiya H. Reconstruction of intercalary bone defect after resection of malignant bone tumor. J Orthop Surg (Hong Kong) 2020; 27:2309499019832970. [PMID: 30879390 DOI: 10.1177/2309499019832970] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [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: 11/15/2022] Open
Abstract
Due to accurate preoperative imaging techniques, early diagnosis and effective chemotherapy, many tumors arising in the metaphyseo-diaphyseal regions of long bones can be segmentally resected with joint preservation. The intercalary resection of malignant bone tumor results in a bone defect which can represent a challenging reconstructive problem. The most commonly used surgical reconstructive options for these defects include biologic reconstructions such as allografts, vascularized fibular grafts, autogenous extracorporeally devitalized tumor bearing bone graft, combination of allografts or devitalized autografts with vascularized fibular grafts, segmental bone transport, or induced membrane technique. Nonbiologic reconstructions, on the other hand, use intercalary endoprostheses. Every patient should be carefully evaluated and the reconstructive option should be individually selected. The aim of this article is to discuss the surgical options of reconstruction of bone defects after intercalary resection of malignant bone tumors with reviewing of their indications, advantages, disadvantages and complications.
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Affiliation(s)
- Karem M Zekry
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.,2 Department of Orthopaedic Surgery, Faculty of Medicine, Minya University, Minya, Egypt
| | - Norio Yamamoto
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Katsuhiro Hayashi
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Akihiko Takeuchi
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Ali Zein Aa Alkhooly
- 2 Department of Orthopaedic Surgery, Faculty of Medicine, Minya University, Minya, Egypt
| | | | | | - Adel Refaat Ahmed
- 3 Department of Orthopaedic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hiroyuki Tsuchiya
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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Morris J, Yang R, Roth M, Gill J, Gorlick R, Lo Y, Hoang BH, Garfein E, Geller DS. Mechanical analysis of the vascularized fibular graft prosthetic composite (VFGPC) for internal hemipelvectomy reconstruction. J Surg Oncol 2017; 115:864-869. [PMID: 28543392 DOI: 10.1002/jso.24593] [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: 11/05/2016] [Accepted: 02/05/2017] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The vascularized fibular graft prosthetic composite (VFGPC) is used for reconstruction after internal hemipelvectomy. The purpose of this study was to create a mathematical model that calculates the mechanical effects of the vascularized fibular graft on the VFGPC. METHODS The effects of the VFG positioning were calculated based on three-dimensional static analyzes to determine the direction, magnitude, and distribution of the forces through the prosthesis and VFG. The shear stress (SS) and cyclic loads to failure (CLF) were calculated. By varying the location of the VFG on the sacrum the zone of acceptable placement was calculated. RESULTS Utilization of the VFG decreased the forces through the implant by 15-35% and decreased SS 20-54%, depending on stance. The CLF improved by 94%. The zone of acceptable placement for the VFG was found to be between 0° and 15° of the vertical axis in the sagittal plane and 0° and 30° of the posterior axis in coronal plane. CONCLUSION Determining the position of the VFG pre-operatively allows for the creation of a customized cutting jig can be utilized to create graft allowing for accurate fibular osteotomies, minimization of ischemia time, and decreased intra-operative handling of the graft.
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Affiliation(s)
- Jonathan Morris
- Department of Orthopaedic Surgery, Montefiore Medical Center and The Children's Hospital at Montefiore, Bronx, New York
| | - Rui Yang
- Department of Orthopaedic Surgery, Montefiore Medical Center and The Children's Hospital at Montefiore, Bronx, New York.,Department of Pediatrics, Montefiore Medical Center and The Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Michael Roth
- Department of Pediatrics, Montefiore Medical Center and The Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Jonathan Gill
- Department of Pediatrics, Montefiore Medical Center and The Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Richard Gorlick
- Department of Pediatrics, Montefiore Medical Center and The Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York.,Department of Molecular Pharmocology, Albert Einstein College of Medicine, Bronx, New York
| | - Yungtai Lo
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Bang H Hoang
- Department of Orthopaedic Surgery, Montefiore Medical Center and The Children's Hospital at Montefiore, Bronx, New York.,Department of Pediatrics, Montefiore Medical Center and The Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Evan Garfein
- Albert Einstein College of Medicine, Bronx, New York.,Department of Plastic and Reconstructive Surgery, Montefiore Medical Center, Bronx, New York.,Department of Otorhinolaryngology, Montefiore Medical Center, Bronx, New York
| | - David S Geller
- Department of Orthopaedic Surgery, Montefiore Medical Center and The Children's Hospital at Montefiore, Bronx, New York.,Department of Pediatrics, Montefiore Medical Center and The Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
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Meloni MC, Hoedemaeker WR, Fornasier V. Failed vascularized fibular graft in treatment of osteonecrosis of the femoral head. A histopathological analysis. Joints 2016; 4:24-30. [PMID: 27386444 DOI: 10.11138/jts/2016.4.1.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE vascularized fibular grafting has been used to treat osteonecrosis of the femoral head in younger patients. Although the results described in the literature are promising, the failure rate is still significant, especially in steroid users. This study was undertaken to learn more, on a histopathological level, about the mechanism of vascularized fibular graft failure. METHODS fifteen femoral heads removed at conversion to total hip arthroplasty were analyzed. The case load comprised 10 men and 5 women. They ranged in age from 28 to 39 years and had a median age of 35 years. The interval between the vascularized fibular implant procedure and the conversion to total hip arthroplasty ranged from 22 months to 30 months; the median interval was 26 months. All the patients were steroid users. The heads were sectioned and axial and coronal sections were taken and stained using the WHO method (hematoxylin, phloxine, saffron and Alcian green). A quantitative and qualitative analysis of graft-host interaction at the head (zone 1), neck (zone 2) and epiphysis (zone 3) was performed. RESULTS all the specimens showed recognizable collapse of the articular surface over the area of necrosis. Thirteen femoral heads showed the presence of an osteochondral flap attached only at the margins of the area of avascular necrosis, and 10 of these 13 femoral heads also showed loss of the articulating surface with an ulcer crater corresponding to the exposed area of avascular necrosis. CONCLUSIONS vascularized fibular graft failure seems to be related to a negative effect of creeping substitution: the revascularization becomes a negative force as it supports unbalanced bone resorption, which, as is well known, is enhanced by corticosteroids. CLINICAL RELEVANCE creeping substitution is an undermining force in the repair and revascularization of the necrotic area in the femoral head.
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Shaker AS, Addosooki AI, El-Deen MA. Anterior Cervical Corpectomy with free vascularized fibular graft versus multilevel discectomy and grafting for Cervical Spondylotic Myelopathy. Int J Spine Surg 2016; 9:60. [PMID: 26767152 DOI: 10.14444/2060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A retrospective study to compare the radiologic and clinical outcomes of 2 different anterior approaches, multilevel anterior cervical discectomy with fusion (ACDF) using autologus ticortical bone graft versus anterior cervical corpectomy with fusion (ACCF) using free vascularized fibular graft (FVFG) for the management of cervical spondylotic myelopathy(CSM). METHODS A total of 15 patients who underwent ACDF or ACCF using FVFG for multilevel CSM were divided into two groups. Group A (n = 7) underwent ACDF and group B (n = 8) ACCF. Clinical outcomes using Japanese Orthopaedic Association (JOA) score, perioperative parameters including operation time and hospital stay, radiological parameters including fusion rate and cervical lordosis, and complications were compared. RESULTS Both group A and group B demonstrated significant increases in JOA scores. Patients who underwent ACDF experienced significantly shorter operation times and hospital stay. Both groups showed significant increases in postoperative cervical lordosis and achieved the same fusion rate (100 %). No major complications were encountered in both groups. CONCLUSION Both ACDF and ACCF using FVFG provide satisfactory clinical outcomes and fusion rates for multilevel CSM. However, multilevel ACDF is associated with better radiologic parameters, shorter hospital stay and shorter operative times.
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Abstract
Reconstruction of large skeletal defects secondary to osteomyelitis remains a challenging problem. Osteomyelitis can result from a variety of etiologies; most often, it is a consequence of trauma to a long bone. Despite advances in antibiotic therapy, treatment of chronic osteomyelitis requires adequate surgical debridement, which can often lead to large soft tissue and bone loss. Free vascularized bone can be used to reconstruct large skeletal defects greater than 6 cm or bone defects of smaller size that failed to heal with nonvascularized bone grafting. The length, cortical strength, and anatomic configuration of the free vascular fibular graft make it an ideal bone graft to bridge extremity defects, and it can be transferred with skin, fascia, and muscle to fill soft tissue defects in the recipient site.
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Affiliation(s)
- Paul Dinh
- University of Southern California, Los Angeles County Medical Center, Los Angeles, California
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