Application of multiple wrapped cancellous bone graft methods for treatment of segmental bone defects

Abstract

Background The aims of this study were to discuss the principle, therapeutic effect and influencing factors of multiple wrapped cancellous bone graft methods for treatment of segmental bone defects. Methods This study retrospectively analyzed the therapeutic effect of different wrapped autologous cancellous bone graft techniques on 51 patients aged (34.5 ± 11.5) years with segmental bone defects. Cancellous bones were wrapped with titanium mesh ( n = 9), line mesh ( n = 10), line suturing or line binding cortical block, ( n = 13), or induced membrane ( n = 19). The bone defeats were as follows: tibia ( n = 23), radial bone ( n = 10), humerus ( n = 8), ulnar bone ( n = 7), and femur ( n = 3). The defect lengths were (5.9 ± 1.1) cm. The functionary recovery of adjacent joint was evaluated by the Paley‘s method and DASH, respectively. Results The incision healed by first intention in 48 cases and secondary healing in 3 cases. All patients were followed up for 19.1 ± 7.1 (12–48) months. Other than one patient with nonunion who received a secondary bone graft, all the patients were first intention of bone healing (the healing rate was 98.0%). The healing time was 6.1 ± 2.1 (3–15) months. There were no significant differences in the healing time among the 4 groups (χ 2 = 1.864, P = 0.601). The incidence of complications in the grafted site was 11.8%, whereas it was 21.6% in the harvest site. At the last follow-up, all the patients had recovered and were able to engage in weight-bearing activities. The functional recovery was good to excellent in 78.4% of cases, there were no significant difference among the 4 groups (χ 2 = 5.429, P = 0.143). Conclusions Wrapped cancellous bone grafting is a modified free bone graft method that can be used in the treatment of small and large segmental bone defects as it prevents loosening and bone absorption after bone grafting. The effect of bone healing is related with the quality and quantity of grafted bone, stability of bone defects, property of wrapping material and peripheral blood supply.

Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis

“…Then, from the end of the 90 s, more and more studies were progressively published, along with a growing interest in other approaches such as bone transport and endoprosthesis 54 , 57 , 60 – 62 , 82 – 84 . Finally, in the last years, all treatments were increasingly addressed but with a focus above all on bone transport and, also due to the impulse of new augmentation procedures, with several studies on bone allograft or autografts 27 – 29 , 31 , 35 , 36 , 45 , 50 , 51 , 53 , 56 , 59 , 77 , 91 .…”

A retrospective cohort study of autogenous iliac strut bone grafting in large bone defects of the lower extremity

“…The major cause of the poor results with cancellous bone grafting in large segmental bone defects is that the grafted bone is readily dispersed and resorbed by movement of surrounding muscles and tendons during postoperative rehabilitation 39 , 40 . Several studies have reported high rates of union using techniques that wrap around the grafted cancellous bone and hold it in place 41 , 42 . The strut bone used in our study also acted to wrap the cancellous bone inside, which may have contributed to a more favorable union rate.…”

Vertical Bonegraft Wrap—A Technique to Increase Soft Tissue Volume in Paranasal Region

“…Other authors have employed the bonegraft wrap in different regions including for small and large segmental bone defects in the lower limbs. 11 Guiol and Schendel 12 used autogenous bonegraft, harvested from bone remnants of Le Fort I osteotomies, whereas Gordon et al 13 used AlloDerm wrapped with cartilage for nasal augmentation. These techniques are very similar to the technique presented in this study, differing by the material used for the wrap and location.…”

“…Klüppel et al (2019)9 described a technique of bonegraft wrap in cases of genioplasty for chin advancement where the bonegraft was involved in Surgicel® (Johnson & Johnson, New Brunswick, NJ, USA), to avoid the accentuated mental lip groove. Other authors have employed the bonegraft wrap in different regions including for small and large segmental bone defects in the lower limbs 11. Guiol and Schendel12 used autogenous bonegraft, harvested from bone remnants of Le Fort I osteotomies, whereas Gordon et al13 used AlloDerm wrapped with cartilage for nasal augmentation.…”