Combined Osteocutaneous Microvascular Flap Procedure for Extensive Bone and Soft Tissue Defects in the Tibia

Donski, P; Büchler, U; Ganz, Reinhold

doi:10.1097/00000637-198605000-00006

Cited by 13 publications

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“…The latissimus dorsi flap was dissected free on the subscapular vessels, with the circumflex scapular artery and vein included in the pedicle. Anastomoses of peroneal vessels to circumflex scapular vessels were performed extracorporeally, as described by Donski et al 13 (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

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Double Vascularized Fibulas for Reconstruction of Large Tibial Defects

Banič¹,

Hertel²

1993

J reconstr Microsurg

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Vascularized fibular grafts have proven to have many advantages over nonvascularized transplants for treatment of large segmental bone defects in the extremities. Fibulas are typically impacted into the medullary canal and fixed with wires or screws. Consolidation has often been delayed and full weightbearing was only possible after graft hypertrophy, usually 12 to 18 months after reconstruction. In order to shorten the time of consolidation and to achieve early full weightbearing, the authors propose a sound biomechanical reconstructive concept: a) stable but not devascularizing osteosynthesis of the osteotomy to shorten the time of consolidation; b) a double-strut fibular graft that yields enough strength for early weightbearing, without the need for bone hypertrophy; and c) additional cancellous bone grafts, to enhance the long-term stability of the reconstruction. Seven patients with tibial defects ranging between 6 and 17.5 cm were treated according to this concept. In four cases, free vascularized fibula was transferred first. Six weeks later, a vascularized, ipsilateral fibula-pro-tibia procedure was done, and the space between the fibulas was filled with cancellous bone grafts. In three patients, a free, vascularized, double-barrel, fibula transfer was done, since the tibial defect was less than 10 cm. Cancellous bone grafts between the fibulas were added only 6 weeks later. In five cases, the free fibula transfer was combined with a latissimus dorsi myocutaneous flap. In six patients, healing was uneventful. In one patient, hypoperfusion of the lower extremity and the vascularized grafts eventually resulted in a below-knee amputation. In all six successful cases, union resulted within 3 months.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Methodsmentioning

confidence: 99%

“…Furthermore, it can be taken as an osteocutaneous flap, 1011 or in combination with muscle flaps such as the soleus 12 or latissimus dorsi muscles. 13 The fibula is generally impacted into the medullary canal and fixed with wires or screws. 814 idation is often delayed.…”

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confidence: 99%

Double Vascularized Fibulas for Reconstruction of Large Tibial Defects

Banič¹,

Hertel²

1993

J reconstr Microsurg

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“…It can be taken as an osteocutaneous flap 14,15 or in combination with muscle flaps such as the soleus muscle. 16 Since consolidation is often delayed and full-weight bearing is usually not possible until graft hypertrophy has developed (generally 12-18 months after reconstruction), it is recommended to stabilize the transferred bone by bypassing it with internal fixation. However, despite the success of this procedure, it is essential to establish bone viability after vascularized bone grafts transfer.…”

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confidence: 99%

Postoperative monitoring of free vascularized bone grafts in reconstruction of bone defects

et al. 2009

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Vascularized bone transfer is increasingly recognized as a very useful and versatile technique for reconstructing large bone defects. It is especially indicated in patients with challenging conditions, such as nonunions, postoncologic resections, severe trauma, and congenital defects. With increasing experience of reconstructive surgeons, improved microsurgical techniques, and more enhanced flaps, the failure rate of free flaps has been reduced in the last decades. Especially, the early-postoperative period is decisive in the outcome of surgery. Several techniques have been described for monitoring the postoperative viability of microsurgical free vascularized graft, and their sensitivity and reliability continues to be the object of animal experiments and clinical trials. The qualities of an optimal monitoring device should be objective, continuous, noninvasive, safe, reproducible, easily managed, and interpretable for the nursing staff, inexpensive, and a clear indicator of changes in arterial and venous circulation. Presently, no one neither fulfills all of the criteria completely nor is uniformly accepted. In this article, relative advantages and disadvantages of these various postoperative monitoring techniques are discussed.

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“…1,4,5,9 Limb salvage often requires multiple procedures. 10 Early cover by free or pedicled muscle flaps is followed by secondary bone reconstruction; composite bone and softtissue transfer can provide both bone and soft tissue. We describe a flap which can cover soft-tissue defects and provide bone.…”

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confidence: 99%

The Fibula-Flexor Hallucis Longus Osteomuscular Flap

Ruch

Koman

1997

The Journal of Bone and Joint Surgery. British volume

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Limb salvage after loss of bone and soft tissue may require many operations to obtain soft-tissue cover and bony continuity. We describe a fibula-flexor hallucis longus osteomuscular flap which can provide both soft tissue and bone in a single stage. The flap is based on the peroneal vessels and is covered by a split-thickness skin graft.We report the results in five patients with an average bone defect of 8.3 cm and soft-tissue and skin loss. All regained a normal gait on the donor side; four had clinical and radiological union with excellent soft-tissue cover, but one required later amputation due to diffuse coagulopathy.The flap provides free vascularised bone with muscle cover. It has a dependable, long pedicle with minimal morbidity at the donor site, and allows monitoring of the vascularity of the fibular graft. The use of vascularised bone grafts is well recognised.

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Combined Osteocutaneous Microvascular Flap Procedure for Extensive Bone and Soft Tissue Defects in the Tibia

Cited by 13 publications

References 0 publications

Double Vascularized Fibulas for Reconstruction of Large Tibial Defects

Double Vascularized Fibulas for Reconstruction of Large Tibial Defects

Postoperative monitoring of free vascularized bone grafts in reconstruction of bone defects

The Fibula-Flexor Hallucis Longus Osteomuscular Flap

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