Double Vascularized Fibulas for Reconstruction of Large Tibial Defects

Banič, Andrej; Hertel, R.

doi:10.1055/s-2007-1006751

Cited by 59 publications

(34 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sufficient bone blood flow must be maintained for the successful repair of large skeletal defects using bone grafts (119)(120). Since the late 1970s, vascularized fibular bone (VFB) grafts have been used to treat osteonecrosis of the femoral head (121).…”

Section: Blood Flow In Bone Graftsmentioning

confidence: 99%

Skeletal Blood Flow in Bone Repair and Maintenance

2013

View full text Add to dashboard Cite

Bone is a highly vascularized tissue, although this aspect of bone is often overlooked. In this article, the importance of blood flow in bone repair and regeneration will be reviewed. First, the skeletal vascular anatomy, with an emphasis on long bones, the distinct mechanisms for vascularizing bone tissue, and methods for remodeling existing vasculature are discussed. Next, techniques for quantifying bone blood flow are briefly summarized. Finally, the body of experimental work that demonstrates the role of bone blood flow in fracture healing, distraction osteogenesis, osteoporosis, disuse osteopenia, and bone grafting is examined. These results illustrate that adequate bone blood flow is an important clinical consideration, particularly during bone regeneration and in at-risk patient groups. IntroductionThe rate at which blood vessels deliver oxygen, nutrients, growth factors, and circulating cells to boneis tightly regulated as a function of blood pressure and vascularizaAll biological tissues, including bone, require vascular support to survive. However, a frequently overlooked feature of bone is its extensive vascular network. Many studies have demonstrated that the blood vessels in bone are necessary for nearly all skeletal functions, including development, homeostasis, and repair (1). In addition, blood vessels lost due to trauma are regenerated, and new bone tissue formed in response to injury is vascularized. As a consequence of this environment, the blood vessels in bone are highly active, not simply a passive source for the delivery of nutrients (2). Readers are referred to recent publications for more information about the active processes of the vasculature not covered in this review, including the vascular niche and hypoxia-driven signaling pathways (3-4). tion. Given that blood pressure is generally maintained, the number and size of blood vessels determines the local blood flow rate. These two factors are regulated through the processes of angiogenesis and vasomotor function, respectively. Although a variety of skeletal disorders are associated with general vascular dysfunction (5-7), this review will focus on the regulation of bone blood flow, through the number and size of vessels, during bone repair and regeneration. To introduce this topic, the skeletal vascular anatomy and techniques for measuring bone blood flow are briefly discussed. Blood supply in boneA dense vascular network delivers oxygen and nutrients to all 206 bones in the human body. In general, this requires a substantial portion of the total cardiac output. Experimental work in various animal species has demonstrated that a significant portion of the resting cardiac output is directed to the skeleton, likely between 10% and 15% (8-12).For some time, the blood flow pattern in bones has been described as primarily centrifugal: blood is supplied to the cortical bone through the nutrient arteries in the (Figure 1), and returned by the periosteal veins (13). Particularly in long bones, the vascular anatomy is well characterized, wi...

show abstract

Section: Blood Flow In Bone Graftsmentioning

confidence: 99%

Skeletal Blood Flow in Bone Repair and Maintenance

2013

View full text Add to dashboard Cite

show abstract

“…The survival rate is not influenced by the absence of the medullary circulation when the periosteal blood flow is preserved, the medullary circulation in such a case being re-established through a reversed periosteal blood flow pattern [6,15]. This is the basis of the success of split fibular flaps, where only the periosteal blood supply is preserved [3,4]. Thus, through a transverse osteotomy, preserving the periosteal connection, the fibular shaft is divided and doubled over, either to produce a larger bone diameter, for example, for reconstruction of weight-bearing long bones [4], or to attain a sufficient height in mandibular reconstruction [3].…”

Section: Discussionmentioning

confidence: 99%

“…This is the basis of the success of split fibular flaps, where only the periosteal blood supply is preserved [3,4]. Thus, through a transverse osteotomy, preserving the periosteal connection, the fibular shaft is divided and doubled over, either to produce a larger bone diameter, for example, for reconstruction of weight-bearing long bones [4], or to attain a sufficient height in mandibular reconstruction [3].…”

Section: Discussionmentioning

confidence: 99%

Ventral cervical fusion at multiple levels using free vascularized double-islanded fibula – a technical report and review of the relevant literature

Krishnan

Müller

2002

Eur Spine J

View full text Add to dashboard Cite

IntroductionVarious methods of spinal stabilization, ranging from multiple wire fixation to complex reconstruction with vascularized bone struts, are described in the literature [21]. The choice of method depends on the specific indications posed by the clinical and morpho-physiological situation. Like any surgical method, each spinal fusion technique has its own pitfalls. Graft resorption, collapse, sequestration and pseudarthrosis formation are some of the common complications in using non-vascularized autogenous and allogenous bone grafts, especially in the old and in patients with compromised healing [7,13]. Screw loosening and plate or rod migration are some problems associated with stabilization using implants [7,8]. It has been suggested that vascularized bone flaps do not undergo resorption, and maintain twice the bone density of non-vascularized grafts [28]. The mechanical stability of vascularized bone used in spinal surgery, both initially and in Abstract Reconstruction of the cervical spine using free vascularized bone flaps has been described in the literature. The reports involve either one level or, when multiple levels, they describe en bloc resection and reconstruction. Stabilization of different levels with a preserved intermediate segment with a single vascularized flap has not been described. We report on the case of a 55-yearold man, who had been operated several times using conventional techniques for cervical myelopathy and instability, who presented to us with severe neck pain. Diagnostic procedures showed pseudarthrosis of C3/4 and stress-overload of the C3/4 and C5/6 segments. The C4/5 fusion was adequately rigid, but avascular. We performed anterior cervical fusion at the C3/4 and C5/6 levels with a vascularized fibula flap modified as a double island. The rigidly fused C4/5 block was preserved and vascularized with the periosteum bridging the two fibular islands. The method and technique are described in detail. Fusion was adequate. Donor site morbidity was minimal and temporary. The patient is symptom free to date (25 months). The suggested method provides the possibility of vertebral fusion at different levels using a single vascularized flap. The indications for this procedure are (1) repeated failure of conventional methods, (2) established poor bone healing and bone non-union with avascular grafts and (3) a well-fused or preserved intermediate segment. The relevant literature is reviewed.

show abstract

“…3 Cortical allograft provides better structural support for the defect, but complete bony incorporation of this graft rarely occurs, and its susceptibility for infection is high. 5 Vascularized cortical autografts have been advocated due to their more reliable incorporation and remodeling with the host; [6][7][8] however, vascularized cortical grafting is a sophisticated, highly specialized procedure that requires prolonged protected weightbearing, is associated with significant donor site morbidity, and has limited availability. 9 Distraction osteogenesis has become a popular alternative for the treatment of large bone defects.…”

Section: Introductionmentioning

confidence: 99%

The efficacy of cylindrical titanium mesh cage for the reconstruction of a critical-size canine segmental femoral diaphyseal defect

et al. 2006

View full text Add to dashboard Cite

ABSTRACT:The authors developed a novel technique for the reconstruction of large segmental long bone defects using a cylindrical titanium mesh cage (CTMC). Although the initial clinical reports have been favorable, the CTMC technique has yet to be validated in a clinically relevant large animal model, which is the purpose of this study. Under general anesthesia, a unilateral, 3-cm middiaphyseal segmental defect was created in the femur of an adult canine. The defect reconstruction technique consisted of a CTMC that was packed and surrounded with a standard volume of morselized canine cancellous allograft and canine demineralized bone matrix. The limb was stabilized with a reamed titanium intramedullary nail. Animals were distributed into four experimental groups: in Groups A ,B, and C (six dogs each), defects were CTMC reconstructed, and the animals euthanized at 6, 12, and 18 weeks, respectively; in Group D (three dogs), the same defect reconstruction was performed but without a CTMC, and the animals were euthanized at 18 weeks. The femurs were harvested and analyzed by gross inspection, plain radiography, computed tomography (CT), and single photon emission computed tomography (SPECT). The femurs were mechanically tested in axial torsion to failure; two randomly selected defect femurs from each group were analyzed histologically. Groups A, B, and C specimens gross inspection, plain radiography, and CT, demonstrated bony restoration of the defect, and SPECT confirmed sustained biological activity throughout the CTMC. Compared to the contralateral femur, the 6-, 12-, and 18-week mean defect torsional stiffness was 44.4, 45.7, and 72.5%, respectively; the mean torsional strength was 51.0, 73.6, and 83.4%, respectively. Histology documented new bone formation spanning the defect. Conversely, Group D specimens (without CTMC) demonstrated no meaningful bone formation, biologic activity, or mechanical integrity at 18 weeks. The CTMC technique facilitated healing of a canine femur segmental defect model, while the same technique without a cage did not. The CTMC technique may be a viable alternative for the treatment of segmental long bone defects. ß

show abstract

Double Vascularized Fibulas for Reconstruction of Large Tibial Defects

Cited by 59 publications

References 5 publications

Skeletal Blood Flow in Bone Repair and Maintenance

Skeletal Blood Flow in Bone Repair and Maintenance

Ventral cervical fusion at multiple levels using free vascularized double-islanded fibula – a technical report and review of the relevant literature

The efficacy of cylindrical titanium mesh cage for the reconstruction of a critical-size canine segmental femoral diaphyseal defect

Contact Info

Product

Resources

About