Bone nonunion management in children with a vascularized tibial periosteal graft

Abstract

Background: Vascularized periosteal graft have demonstrated a tremendous bone healing capacity in children. The objective is to report outcomes on the use of vascularized tibial periosteal graft (VTPG) during bone reconstruction in a series of children with complex bone healing problems. Patients and methods: Cases were collected retrospectively since May 2013 to May 2019, excluding cases of congenital pseudarthrosis of the tibia. Mean age at surgery was 12.8 (range 11-18) years. Indications included treatment of recalcitrant bone nonunion and the prevention of bone allograft-host junction nonunion in seven and three patients, respectively. The periosteal flap, based on the anterior tibial vessels, was harvested as a free flap in six instances and as a pedicled flap in four. Results: Mean follow-up was 25.2 months (range 8-36). The flap showed a 13.6 cm (range 9-16) and mean width 3.4 cm (range 2.7-3.9). Early bone union was achieved, initially through periosteal callus, followed by cortical union at mean times of 2 and 4 months, respectively, in nine cases. The flap was not successful in a patient with severe comorbidities. No donor site complications were registered. Conclusions: VTPG was fast and high effective for the treatment complex bone nonunion or the prevention of allograft nonunion in children.

Periosteal medial femoral condyle free flap for metacarpal nonunion

“…The PMFC flap should be considered as an alternative in cases of Soldado et al, 2020). The same group also reported a favorable outcome in adult scaphoid nonunion management with a similar technique (Barrera-Ochoa et al, 2020).…”

“…Several studies have assessed the use of periosteal flaps for nonunion management, mostly in children. Soldado et al have shown excellent results using various free and pedicled periosteal flaps without bone graft in skeletally immature patients (Barrera‐Ochoa et al, 2018 ; Soldado et al, 2020 ). The same group also reported a favorable outcome in adult scaphoid nonunion management with a similar technique (Barrera‐Ochoa et al, 2020 ).…”

Free vascularized iliac periosteal graft for bilateral forearm nonunion reconstruction in a child with bilateral transfemoral amputation

“…High union rates and excellent clinical outcomes have been reported with VPF in the treatment of complex situations in the pediatric population, including (such as recalcitrant nonunion, avascular necrosis, or massive bone defects; Soldado et al, 2012; 2015). In our experience, some VPF have been used with good results in these complex situations, including vascularized tibial periosteal graft in children with complex bone healing problems or vascularized humeral periosteal flap to treat lateral humeral condyle nonunion (Barrera‐Ochoa et al, 2019; Soldado et al, 2020).…”

Congenital pseudarthrosis of the tibia: Rate of and time to bone union following contralateral vascularized periosteal tibial graft transplantation

“…For VTPG harvesting, we adhered to the technique previously described by Soldado et al (2020). A skin island was included in all cases to monitor vascular anastomosis status.…”