BACKGROUND: The use of a vascularized fibular graft during reconstructive interventions on the limbs in children is a promising direction in the replacement of extensive bone defects in children. AIM: This study aimed to conduct a systematic review of the literature on microsurgical transplantation of a fragment of the fibula in the replacement of long bone defects in children. MATERIALS AND METHODS: Articles were searched in systems such as eLibrary, PubMed, and Google Scholar, with a search time range of 10 years (from 20122022, last query 11/08/2022). The following keywords were used for searching in Russian-language search engines: replacement of bone defects in children and fibula transplantation in children, and in the English-language search engines, microsurgical and fibula, microvascular and fibula, and bone and defect were used. After sorting the published studies, 17 publications were analyzed. RESULTS: The study analyzed a total of 690 patients (mean age 12 2.6 years). The predominant cause of the defects was malignant tumors in 647 patients (93.7% of all patients). Benign processes were also noted, which accounted for 0.87% of all patients: osteomyelitis, 2.0%; congenital pathology, 2.17%, and trauma, 1.45%. The mean follow-up period was 4.8 2.4 years. The survival rate of patients with cancer was 78.4%. Donor-side complications accounted for 14.7% of all complications. Recipient-zone complications were frequent and accounted for 85.3% of all complications (n = 457 cases). The main type of complications reported in the studies was graft fracture or fracture at the graft-bone level (35.7% of all complications). CONCLUSIONS: The use of a fragment of the vascularized fibula in the replacement of extensive bone defects enables a one-stage reconstruction of the limb with good long-term results in large segmental defects of various features. Despite the complications, this technique is one of the few that enables simultaneous limb reconstruction. The decision to use microsurgical fibula autotransplantation is based on the preference and surgical experience of the surgeon.
BACKGROUND: Numerous methods are available for the treatment of congenital pseudarthrosis of the tibia, but none of them offers a 100% satisfactory result and does not exclude the development of repeated refractories. One of the treatment methods is vascularized transplantation of a fragment of the fibula into the position of the defect of the tibia. However, the achievement of consolidation of the bone fragments of the lower leg does not stop the series of interventions necessary to restore the function of the affected segment. Therefore, specialists were asked about the advisability of performing amputations as an alternative to long-term and multistage interventions. AIM: To analyze the results of the use of microsurgical techniques for the treatment of patients with congenital pseudarthrosis of the tibia and, using the example of a patient, to show the way of multistage reconstruction of the lower limb. MATERIALS AND METHODS: The results of the use of microsurgical techniques in the elimination of a defect in the bones of the leg in five patients with congenital pseudarthrosis of the tibia were analyzed. Age, sex, presence of type 1 neurofibromatosis, bone defect size, autograft size, duration of consolidation, osteosynthesis index, refractory, range of joint motion, and secondary deformities of the segments after consolidation were assessed. The course of the patient when performing severe reconstructive interventions to restore the weight-bearing capacity of the limb was described. Vascularized autograft transplantation was performed by a qualified microsurgical team. RESULTS: The mean age was 7.8 2.2 years. Boys predominated, and type 1 neurofibromatosis was detected in 60% of the cases. The average defect size was 8.8 1.6 cm, and the autograft size was 10.8 1.6 cm. The duration of fixation was 260 90 days, and the fixation index was 24.6 10.6 days/cm. In two cases, 1 year after the fibula transfer, refractories were noted at the bonegraft interface. In 100% of the cases, patients had fibrous ankylosis at the level of the ankle joint, with a loss of functional range of motion, and in 40% of cases, there were flexionextension contractures of the knee joints with an extension deficit of up to 20. For this observation period, 3 of 5 patients underwent additional surgical interventions to correct the deformities of the affected limb. CONCLUSIONS: The use of VFT in patients with congenital pseudarthrosis of the tibia allows restoring the integrity of the tibia. Multiple interventions performed on the same segment can lead to irreversible secondary changes in adjacent joints and loss of function of this limb.
Background. Congenital radial club hand (CRCH) is characterized by longitudinal underdevelopment of the forearm and hand on the radial surface. Underdevelopment can range from hypoplasia to aplasia of the radius. More than 50 methods to correct the forearm deformities, depending on the degree of radius underdevelopment, have been proposed. Aim. We evaluated the results of CRCH treatment using microsurgical technique and external fixation. Methods. We analyzed 16 patients (age, 4.6 0.9 years) with CRCH type II, according to the classification of Bayne and Klug, treated between 1994 and 2017. The patients were divided into two groups: Group 1 were patients undergoing microsurgical autotransplants of the epimetaphyseal second metatarsal bone with growth plate to the position of the radius defect and group 2 were patients treated by lengthening of the radius with external fixation. We analyzed the types of deformities, size of the radius defects, and range of motion in upper limb joints before the stage of the lengthening. External fixation index and number of complications also were determined. The type and number of recurrent deformities and timing of their detection were analyzed. Results. The observation period ranged from 12 months to 10 years (average, 3.8 years). In group 1, good results were obtained in 62.5% of cases. After transplantation of the metatarsal bone growth plate, the work of the growth plate continued, characterized by increasing radius length in the later observation period. In group 2, good results were obtained in 50% of cases. Clinical and X-ray examinations showed recurrent hand deviation and radius shortening, which required repeated radius lengthening. Conclusion. Microsurgical transplantation of the second metatarsal bone with growth plate is accepted more in reconstruction of the radial bone in patients with CRCH type II due to creation of a growth zone in the distal part of the radius. Radius lengthening via external fixation is applicable while maintaining the distal epimetaphysis and normal transverse dimensions of the radial bone.
Background. Applications of traditional treatment methods in children with congenital and acquired pathology of the musculoskeletal system are often limited, as wound defects of significant area and depth with a soft tissue and bone deficit may occur during the reconstruction of the segment. Microsurgical techniques, including autotransplantation of blood-supplied tissue complexes, make it possible to realize the aims of musculoskeletal segment reconstruction and reduce surgical treatment time. Aim. This study aimed to perform a retrospective (statistical) analysis of using microsurgical autotransplantation of tissue complexes in children. Materials and methods. Treatment outcomes of 871 patients with congenital and development deformities of the musculoskeletal system who underwent 1048 microsurgical autotransplantations of various tissue complexes in 19842018 were analyzed. Complications associated with impaired blood supply to transplanted autografts, requiring revision microsurgical interventions, were also statistically processed. Results. The mean patient age was 5.8 years (range, 10 months to 17 years). In children with congenital pathology (n = 597), transplantation of blood-supplied tissue complexes in 85.9% of the cases was performed in cases with hand deformities. In 285 cases of acquired deformities, post-traumatic finger stumps accounted for 45.5%, scar changes of soft tissues for 39.6%, and other pathological conditions for 14.9%. Most of the microsurgical operations were toe-to-hand transfers, which accounted for 81.8% of the total number of surgeries. In 79.4% of the cases, the second toe was used for the toe-to-hand transfer. Accordingly, the remaining toes were transferred in 20.6% of the cases. When replacing soft tissue defects, a thoracodorsal flap was used in 84 cases, which was 5.6% (of the total number of autotransplantations), and a groin flap was used in 22 patients. To replace bone defects, a blood-supplied fibula graft was used in 47 patients and a metatarsal bone graft in 41 children. Circulatory disorders in the postoperative period were noted in 5.9% of the total operations, which in 3.1% of cases resulted in the necrosis of the transplanted autograft. Conclusion. The treatment outcomes of using microsurgical autotransplantation of blood-supplied tissue complexes in the reconstruction of tissues and segments of the musculoskeletal system confirm their high efficacy.
BACKGROUND: Extensive and deep limb defects remain a difficult problem of reconstructive surgery in children. Free microsurgical flaps are used to resolve this problem. Free flaps can be complex in composition and include muscles and bone parts, which allow replacing large and multicomponent limb defects. The technique is used in patients with posttraumatic deformities, burns, acquired limb deformities, and congenital deformities of the extremities. AIM: To retrospectively analyze free flaps in children for the replacement of limb defects. MATERIALS AND METHODS: This single-center retrospective study analyzed 120 cases of microsurgical autotransplantation of free flaps to replace defects of the upper and lower extremities in children. The patients were children aged 117 years who had injuries and burns, acquired limb deformities, and congenital limb deformities. RESULTS: The average age of the patients was 9.5 years, and 72% of the patients were boys. Moreover, 95% of the children had posttraumatic deformities, burns, and acquired pathologies. Free latissimus dorsi flaps were used in 70% of the patients. The recipient area was the upper limb in 53% of the cases. The survival rate of free flaps was 96%. The general surgical complications were inflammation, pneumothorax, deformities, and specific vascular thrombosis. CONCLUSIONS: Replacement of extensive limb defects with free flaps remains a practical method in children.
BACKGROUND: The shortening of the forearm in children with congenital radial clubhand and multi-plane deformity of the ulna is challenging to treat by surgery. The literature shows single studies using the Ortho-SUV frame for the correction of forearm deformity in multiple exostosis chondrodysplasia and patients with posttraumatic deformities. CLINICAL CASE: A 17-year-old patient with congenital radial clubhand who had a relapse of hand deviation undergo correction of forearm deformity. The elimination of radial hand deviation and ulnar deformity correction in the distal part with subsequent elongation were performed. DISCUSSION: No data on the use of the Ortho-SUV frame for the correction of ulnar multiplanar deformity in radial clubhand are available. Indicators, i.e., fixation index, osteosynthesis index, lengthening, and complications, were compared with the indicators used for ulnar elongation with a small angle of radial deviation of the hand. CONCLUSIONS: Personalized plan of forearm deformity correction based on the anatomical features of the congenital radial clubhand and X-ray indicators allowed achieving good cosmetic and functional results.
Background. Congenital radial club hand is characterized by the radial deviation of the hand, the longitudinal underdevelopment of the forearm, and the dysfunction of the upper limb. The shortening of the ulna is observed in all types of congenital radial club hand. The average shortening of the ulna surgical treatment was 33.3% compared to the intact contralateral side. Aim. This study aimed to evaluate the results of ulna elongation by the method of external fixation, depending on the level of osteotomy, in patients with congenital radial club hand type IIIIV. Materials and methods. The treatment results of 36 patients with congenital radial club hand type IIIIV from 1998 to 2018 were analyzed. The average age of the patients was 7.4 years 3.5 years. The patients were divided into three groups, depending on the level of ulnar osteotomy. Shortening of the ulna, correction of the angle of deformity of the ulna, radial deviation of the hand, period of correction, elongation obtained, index of fixation and osteosynthesis, and associated complications were analyzed. Results. The observation period was an average of 5.8 years. Before surgical treatment, the ulna was 33.3% shorter, while after surgery, it was 16%. Before surgery, the angle of deformation was 20.5 14.8, while after surgery, it was 7.4 5.6; this gives an angle of deformity correction of 63.9%. The elongation of the ulna was 3.2 1.1 cm. In patients who underwent proximal osteotomy, the resulting elongation was 32% and 18.4% more, respectively, than in patients who underwent an osteotomy in the middle and distal sections of the ulna. In group 1, the correction period was 24.4% and 28.9% more than in groups 2 and 3, respectively. The index of fixation in group 1 was 53.6%, which was 45.7% less than in groups 1 and 3. Postoperative complications included a false joint (15%), inflammation (10%), and forearm deformities (7.5%). Conclusions. In patients with congenital radial club hand type IIIIV, the optimal part of an ulna osteotomy is the proximal section. With a hand deviation of more than 20, osteotomy is performed in the distal section with simultaneous correction of the deformity.
Хирургическому лечению пациентов с крайними формами расщепления кистей и стоп (SHFM) посвящено незначительное количество работ. Основная цель хирургического лечения-восстановление максимально эффективного схвата между двумя пограничными пальцами, что возможно за счет микрохирургической аутотрансплантации пальца со стопы на кисть. Цель исследования: провести ретроспективный анализ лечения пациентов детского возраста с SHFM, которым выполняли микрохирургическую аутотрансплантацию 5-го пальца стопы в позицию 1-го пальца кисти. Проведена оценка результатов лечения 17 пациентов с SHFM, которым была выполнена свободная пересадка 5-го пальца стопы в позицию 1-го пальца кисти в период с 1984 по 2019 гг. Были проанализированы протоколы оперативных вмешательств и данные: возраст и пол пациента; варианты донорских и реципиентных сосудов; виды реконструкций на кисти; осложнения, количество последующих оперативных вмешательств. Выполнено 26 микрохирургических аутотрансплантаций 5-го пальца стопы в позицию 1-го пальца кисти. Средний возраст пациентов составил 4,1±2,5 года. Заимствование трансплантата на стопе производили на малой (58%) и большой (27%) подкожных венах. В 65,4% случаев тыльная артерия стопы отсутствовала, кровоснабжение осуществлялось только из подошвенных артерий. У 46,1% пациентов подошвенная артерия стопы была представлена только одной веткой. В 85% случаев выполняли различные реконструкции 1-й пястной кости. На кисти использовали лучевую (31%) и локтевую артерии (27%), поверхностную ладонную дугу (23%). При наложении венозных анастомозов в 61% случаев использовали v. сephalica. В 23% случаев в первые 3 суток отмечалось нарушение микроциркуляции в пересаженных трансплантатах. В 15,4% случаев выполнена некрэктомия. Проведенное исследование показало эффективность применения данной методики у детей с SHFM. Ключевые слова: микрохирургия, кисть, расщепление, дети, врожденная патология.
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