Experimental Transplantation of Small Joints by Microvascular Anastomoses

Hurwitz, Peter Joel

doi:10.1097/00006534-197908000-00015

Cited by 62 publications

(9 citation statements)

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“…In the longer term, replacement of the ischemic capsule by rigid, contracted scar tissue may restrict the movement eventually obtained in the joint. This effect of ischemia in nonvascularized joint transfers was noted experimentally by Hurwitz 36 who also noted that vascularized joints prevented these adverse changes. The role of denervation in degenerative change in transplanted joints is poorly documented, 23 but is probably relatively unimportant.…”

Section: Discussionmentioning

confidence: 54%

Free Vascularized Toe-Joint Transfer in Hand Reconstruction: A Series of 25 Patients

Foucher¹,

Sammut²,

Citron³

1990

J reconstr Microsurg

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Twenty-eight vascularized toe-joint transfers performed on 25 patients were reviewed. A number of different techniques were used: proximal interphalangeal joint or metacarpophalangeal joint reconstruction, one-stage double joint transfer, and interphalangeal thumb or trapezometacarpal joint replacement. Using these types of vascularized joint transfer allows one-stage composite transfer (including skin, bone, and extensor tendon) and provides rapid bone healing, potential growth in the young, good long-term cartilage preservation, normal lateral stability in pinch, and limited but useful range of motion (mainly at the proximal interphalangeal level).

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Section: Discussionmentioning

confidence: 54%

Free Vascularized Toe-Joint Transfer in Hand Reconstruction: A Series of 25 Patients

Foucher¹,

Sammut²,

Citron³

1990

J reconstr Microsurg

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“…Experimental transplantation of metacarpophalangeal joints with microvascular anastomoses in dogs were shown to be possible in 1979 by Hurwitz27) and several subsequent studies have shown satisfactory growth potential remaining in the epiphysis following transfer and revascularization 28,29). Clinical series of vascularized MTP-joint transfer with epiphyseal growth have been reported following the reconstruction of pediatric joint injuries and following toe transfer for reconstruction of the adactylous hand 30,31)…”

Section: Vascularized Second Metatarsal Phalangeal Joint Transfer Formentioning

confidence: 99%

Changing Paradigms in the Treatment of Radial Club Hand: Microvascular Joint Transfer for Correction of Radial Deviation and Preservation of Long-term Growth

2012

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Radial longitudinal deficiency, also known as radial club hand, is a congenital deformity of the upper extremity which can present with a spectrum of upper limb deficiencies. The typical hand and forearm deformity in such cases consists of significant forearm shortening, radial deviation of the wrist and hypoplasia or absence of a thumb. Treatment goals focus on the creation of stable centralized and functionally hand, maintenance of a mobile and stable wrist and preservation of longitudinal forearm growth. Historically centralization procedures have been the most common treatment method for this condition; unfortunately centralization procedures are associated with a high recurrence rate and have the potential for injury to the distal ulnar physis resulting in a further decrease in forearm growth. Here we advocate for the use of a vascularized second metatarsophalangeal joint transfer for stabilization of the carpus and prevention of recurrent radial deformity and subluxation of the wrist. This technique was originally described by the senior author in 1992 and he has subsequently been performed in 24 cases with an average of 11-year follow-up. In this paper we present an overview of the technique and review the expected outcomes for this method of treatment of radial longitudinal deficiency.

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“…[31][32][33][34][35][36] Thumb reconstruction techniques may be pursued, such as bone lengthening, bone grafting, toe-to-thumb transfer, or microvascular anastomosed joint transfer. [34][35][36][37][38][39] However, these options and outcomes are limited due to donor-site morbidity and in the availability of tissue. 34,35 Prosthetic joint reconstruction is available, but is not an attractive option, as it may be compromised by limited durability of the nonbiological materials or by intractable infection.…”

Section: Introductionmentioning

confidence: 99%

Toward Regenerating a Human ThumbIn Situ

Weinand

Gupta

Weinberg

et al. 2009

Tissue Engineering Part A

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Regenerative technology promises to alleviate the problem of limited donor supply for bone or organ transplants. Most expensive and time consuming is cell expansion in laboratories. We propose a method of magnetically enriched osteoprogenitor stem cells, dispersed in self-assembling hydrogels and applied onto new ultra-high resolution, jet-based, three-dimensional printing of living human bone in a single-step for in situ bone regeneration. Human bone marrow-derived mesenchymal stem cells (hBMSCs) were enriched with CD 117+ cells, dispersed in different collagen I and RAD 16I hydrogel mixes, and applied onto three-dimensional printed btricalcium phosphate=poly(lactic-co-glycolic acid) scaffolds, printed from ultra-high-resolution volumetric CT images of a human thumb. Constructs were directly implanted subcutaneously into nude mice for 6 weeks. In vivo radiographic volumetric CT scanning and histological evaluations were performed at 1, 2, 4, and 6 weeks, and expression of bone-specific genes and biomechanical compression testing at 6 weeks endpoint. Time-dependant accumulation of bone-like extracellular matrix was most evident in CD 117+ hBMSCs using collagen I=RAD 16I hydrogel mix. This was shown histologically by Toluidine blue, von Kossa, and alkaline phosphatase staining, paralleled by increased radiological densities within implants approximating that of human bone, and confirmed by high expression of bone-specific osteonectin and biomechanical stiffness at 6 weeks. Human origin of newly formed tissue was established by expression of human GAPDH using RT-PCR. Statistical analysis confirmed high correlations between biomechanical stiffness, radiological densities, and bone markers. Bone tissue can be successfully regenerated in vivo using a single-step procedure with constructs composed of RAD 16I=collagen I hydrogel, CD 117+-enriched hBMSCs, and porous b-tricalcium phosphate=poly(lactic-co-glycolic acid) scaffolds.

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Experimental Transplantation of Small Joints by Microvascular Anastomoses

Cited by 62 publications

References 0 publications

Free Vascularized Toe-Joint Transfer in Hand Reconstruction: A Series of 25 Patients

Free Vascularized Toe-Joint Transfer in Hand Reconstruction: A Series of 25 Patients

Changing Paradigms in the Treatment of Radial Club Hand: Microvascular Joint Transfer for Correction of Radial Deviation and Preservation of Long-term Growth

Toward Regenerating a Human ThumbIn Situ

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