Folded free vascularized fibular grafts for the treatment of subtrochanteric fractures complicated with segmental bone defects

Liang, Kunneng; Xiang, Zhou; Chen, Shuo; Cen, Shiqiang; Zhong, Gang; Yi, Min; Huang, Fuguo

doi:10.1097/ta.0b013e31824473ce

Cited by 11 publications

(7 citation statements)

References 24 publications

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“…Infection definition varies between the included studies and several different surgical techniques were used. Although we cannot give evidence to support this recommendation, most of the studies suggest a two step reconstruction as the standard approach to manage infected bone defects: an extensive debridement, followed by antibiotic treatment before graft surgery [16, 21, 26, 29, 31, 32, 36, 40, 43, 44]. Furthermore, some of the studies use PMMA as a local antibiotic delivery and/or due to its ability to induce a biological membrane at the defect site [21, 29, 32–34, 36].…”

Section: Discussionmentioning

confidence: 99%

Autologous bone graft in the treatment of post-traumatic bone defects: a systematic review and meta-analysis

Azi

Aprato

Santi

et al. 2016

BMC Musculoskelet Disord

115

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BackgroundThis meta-analysis aimed to determine the bone union rate of bone defects treated with the different autologous bone graft techniques.MethodsThe PubMed and the Cochrane Library databases were searched using the terms: ‘fracture’ AND (‘bone loss’ OR ‘defect’ OR ‘defects’) AND ‘bone graft’, restricted to English language, to human species, and to a publication period from January 1999 to November 2014. Data were extracted by one of the reviewers and then checked by the second. A quality of evidence score and a methodology score were used. Heterogeneity was assessed. A random effects model approach was used to combine estimates.ResultsOut of 376 selected studies only 34 met the inclusion criteria. The summary pooled union rate was 91 % (95 % CI: 87–95 %) while union rate after additional procedures raised to 98 % (95 % CI 96–99 %). No association between union rate and bone defect size was found. (Univariable regression model: vascularized: P = 0.677; non-vascularized: 0.202. Multivariable regression model: vascularized: P = 0.381; non-vascularized: P = 0.226). Vascularized graft was associated with a lower risk of infection after surgery when compared to non-vascularized graft (95 % CI 0.03 to 0.23, p < 0.001).ConclusionThe results of this meta-analysis demonstrate the effectiveness of autologous graft for bone defects. Furthermore, from the available clinical evidence bone defect size does not seem to have an impact on bone union when treated with autologous bone graft techniques.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1312-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Autologous bone graft in the treatment of post-traumatic bone defects: a systematic review and meta-analysis

Azi

Aprato

Santi

et al. 2016

BMC Musculoskelet Disord

115

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“…Mostly, the fibula was cut into segments and folded to fit the bony cavity (Fig. 2) [10,11]. Under microscope, one artery and two veins of the free fibular were anastomosed to the dissected vessels in the host site with 10-0 microsurgical stitches, reinstituting both arterial inflow and venous outflow to the fibular graft.…”

Section: Methodsmentioning

confidence: 99%

“…Since Taylor GI et al [9]. Firstly used vascularized fibular graft to reconstruct a large defect in a tibia in 1975, free vascularized fibular graft has been widely accepted for the reconstruction of long bone defect, especially when the defect is greater than 6cm [10,11]. Malizos KN et al stated that free vascularized fibular graft is also indicated if the blood supply of lesion site is deficient [39].…”

Section: Table1．clinical Details Of Patientsmentioning

confidence: 99%

Vascularized Fibular Graft Reconstructing Large Bone Defects after Extended Curettage of Osteolytic Lesions in Lower Extremities

2019

ARC Journal of Clinical Case Reports

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Background: Benign lytic lesions of bone encompass a group of neoplasm or disorders of human skeleton. Planning a treatment protocol for patients with osteolyic lesions of lower extremity involves many concerns of different risks. Especially, the reconstruction of large bony defects following surgical resection of the lesions presents a challenge for the operating surgeon. Materials and Methods: Twenty-three cases of benign bone tumors or tumor-like lesions in the lower extremities treated between April 2013 to March 2016 were retrospectively analyzed. Lesion was scooped out with extended curettage technique and the tumor wall was treated by zinc chloride. Vascularized fibular grafting with or without plate fixation were performed to reconstruct bone defect. The patients were followed up and assessed with the MSTS score (Musculoskeletal Tumor Society score) and radiological images. Results: The mean follow-up term is for 43.1 months, ranging from 24 to 77 months. One patient of giant cell tumor developed recurrence at 12-month follow-up, who finally died from lung metastasis. The other 22 patients showed no sign of recurrence. Overall, there was no evidence of avascular necrosis of fibular graft in any case. The average time of bony union between vascularized fibular graft and the receipt site was 4.3 months (rang, 2-7 months). The mean MSTS scores of pre-operation and post-operation were (80.87 ± 23. 49) % and (93.19 ± 17. 39) %, respectively, which showed that the functional outcomes of affected limbs were averagely restored to excellent level at the final follow-up. Conclusions: The outcomes showed that vascularized fibular grafting following extended curettage and zinc chloride treating is a reliable and effective surgical option in the management of benign bone tumors or tumorlike lesions in the lower extremities.

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“…Despite the absence of a universal treatment protocol, there has been a marked improvement in the knowledge and management of ONFHN in the most recent decades due to the accumulation of further research on the multiple treatment methods. [1][2][3][4]6,[8][9][10][11][12][13][15][16][17][18][19][20][22][23][24][25][26][27][28][29][30][31][33][34][35][36][37][39][40][41][42][43]51 The treatment options for patients are categorized as surgical and nonsurgical interventions. The nonsurgical treatments include restricted weight bearing protocols and pain management, while the surgical options include core decompression (CD) and osteotomy, nonvascularized structural grafts, electrical stimulation, vascularized bone grafts, and THR or total hip arthroplasty (THA).…”

mentioning

confidence: 99%

“…1,9,17,21,23,24,32,34,41,43,47,48,54 Free vascularized fibular flaps (FVFFs) have been studied in the most recent decade and have shown to be associated with low rates of conversion to THR and increases in HHS, an indicator of functionality, symptoms, and range of motion. [1][2][3][4][5][6][7][8][9][10][11][12][15][16][17][18][19][20]22,23,[25][26][27][28][31][32][33][34][35][36]38,[40][41][42]45,46,49,50,…”

mentioning

confidence: 99%

The Effectiveness of Free Vascularized Fibular Flaps in Osteonecrosis of the Femoral Head and Neck: A Systematic Review

Ligh

Nelson

Fischer

et al. 2017

J reconstr Microsurg

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Free vascularized fibular flaps (FVFFs) are accepted surgical options to treat osteonecrosis of the femoral head and neck (ONFHN) to prevent conversion to total hip replacement (THR), yet many studies are single institution cohorts, with little generalizability. The purpose of this study was to perform a systematic review examining the comparative effectiveness of FVFF to treat ONFHN, particularly preventing conversion to a THR and improving hip function/symptoms. We searched PubMed and EMBASE databases using femoral head, free fibula, and femoral neck keywords. Articles were excluded if not translated into English, < 10 hips, article was a compilation/review, outcomes were not relevant, or prior to 1994. If from the same institution, we included the largest cohort and excluded others within the same timeline. Two investigators independently reviewed articles and reported number of patients/hips, average age/follow-up time/graft survival before THR, Harris hip score, THR rate, complications, and radiographic progression rates. We identified 128 and 157 articles from PubMed and EMBASE. After screening/duplicate removal, 21 studies were included from 14 institutions in 9 countries. Overall, 71% were level IV evidence. The average patient number was 129, number of hips was 166, age at surgery was 34 years, and follow-up time was 92 months. HHS improved on average 21.7 points, with the number of patients requiring THR being 19.4%. Graft survival before THR was 5.2 years, and 47.7% of hips had radiographic progression. There is a significant amount of level IV evidence describing the favorable role of FVFF to treat ONFHN. Although efficacious, there is a need for higher level evidence. The level of evidence is 3.

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Folded free vascularized fibular grafts for the treatment of subtrochanteric fractures complicated with segmental bone defects

Abstract: V, therapeutic study.

Cited by 11 publications

References 24 publications

Autologous bone graft in the treatment of post-traumatic bone defects: a systematic review and meta-analysis

Autologous bone graft in the treatment of post-traumatic bone defects: a systematic review and meta-analysis

Vascularized Fibular Graft Reconstructing Large Bone Defects after Extended Curettage of Osteolytic Lesions in Lower Extremities

The Effectiveness of Free Vascularized Fibular Flaps in Osteonecrosis of the Femoral Head and Neck: A Systematic Review

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