Free fibula flap for humerus segmental reconstruction: report on 13 cases

Adani, Roberto; Delcroix, Luca; Innocenti, Marco; Tarallo, Luigi; Baccarani, Alessio

doi:10.1007/s12306-007-0004-5

Cited by 14 publications

(11 citation statements)

References 35 publications

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“…The newly emerging membrane induction technology requires a second surgical treatment, which greatly increases the patient's pain and medical expenses [ 19 ]. The microsurgery technique will increase the damage to the donor site, making it unacceptable for some patients [ 20 ]. Once improperly handled, the infection recurs, which will lead to failure of implant fixation or bone grafting.…”

Section: Discussionmentioning

confidence: 99%

Effect of Anti-Infective Reconstituted Bone Xenograft Combined with External Fixator on Serum CRP and PCT Levels and Prognosis of Patients with Bone Infection after Lower Extremity Long Bone Trauma

Wang

Liu

Qiu

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Bone infection is one of the common complications of orthopedic surgery. After bone trauma occurs in the human body, the infection of Staphylococcus aureus and Gram-negative bacteria into the fracture area can lead to double infection of the soft tissue and bone tissue at the fracture site, leading to a variety of complications, mostly in the lower extremities. Bone infection easily causes bone destruction, bone nonunion, and bone defect, seriously affecting the quality of life of patients. The traditional treatment method of bone infection is to control the infection first and then repair the bone graft, but this method has a long course, poor efficacy, and high disability rate. In this study, anti-infective reconstituted bone xenograft (ARBX) combined with external fixation was used to treat patients with posttraumatic bone infections of the long bones of the lower extremities, to explore its efficacy, and to analyze its effects on serum CRP, PCT levels, and prognosis. Our results showed that ARBX combined with the external fixator had a good effect on the treatment of patients with bone infection after lower extremity long bone trauma, which could effectively enhance the repair and functional recovery of the limb bone, significantly alleviate the infection degree of patients, reduce the inflammatory response of the body, and have a good prognosis.

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Section: Discussionmentioning

confidence: 99%

Effect of Anti-Infective Reconstituted Bone Xenograft Combined with External Fixator on Serum CRP and PCT Levels and Prognosis of Patients with Bone Infection after Lower Extremity Long Bone Trauma

Wang

Liu

Qiu

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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“…The two patients with the most limited recovery were reconstructions involving resection of the humeral head, which reflects findings of other authors who have also reported limited functionality following reconstruction of the glenohumeral joint. 14,28 While both patients with humeral head reconstructions in our own series reported excellent adaptive functionality, one patient was considering an arthroplasty for persistent pain at most recent follow-up 3 years postoperatively. The lower MSTS scores for these two patients also help explain the lower average MSTS score for upper extremity compared with lower extremity reconstructions.…”

Section: Discussionmentioning

confidence: 83%

Surgical Outcomes, Complications, and Long-Term Functionality for Free Vascularized Fibula Grafts in the Pediatric Population: A 17-Year Experience and Systematic Review of the Literature

McCullough

Arkader

Ariani

et al. 2020

J Reconstr Microsurg

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Background In the pediatric population, bony defects of the extremities pose a significant challenge for which free vascularized fibular grafts (FVFGs) represent a valuable reconstructive option. The purpose of this study was to explore surgical outcomes, complications, and long-term functionality of FVFG for this patient group. Methods Using MEDLINE and PubMed databases, studies were identified of pediatric extremity reconstruction using FVFG which reported functional outcomes and/or complications. The operative logs at a tertiary pediatric center were then reviewed for cases of FVFG between January 2000 and 2017. Demographic characteristics, surgical indications, operative details, graft survival, bony union, complications, and functionality of the reconstruction were recorded. Results A total of 366 studies were identified with 23 ultimately meeting inclusion criteria in the systematic review. In the institutional series, 29 patients were included with mean age of 9.7 years (1–17 years). Indications for reconstruction included malignant bone tumor (n = 11), osteomyelitis (n = 9), congenital pseudoarthrosis (n = 6), and osteofibrous dysplasia (n = 3). Major postoperative complications included graft nonunion (24.1%), fracture (17.2%), and hardware failure (17.2%). Thirteen patients (44.8%) experienced delayed complications, while two (6.8%) experienced an immediate complication. Complications occurred in the donor site in 2 cases and the recipient site in all 13 cases. Long-term graft survival was achieved in 27 patients (93.1%), and 23 (79.3%) had full functional recovery, with an average Musculoskeletal Tumor Society score of 90% (60–100%). Mean follow-up was 5.17 years (2–12 years). Conclusion This review and institutional series demonstrate the versatility of FVFG to facilitate limb reconstruction in large defects or serve as a salvage option in complex cases. While immediate and donor-site complications are uncommon, delayed recipient-site complications are frequent, and patients and families should be counseled regarding this expectation. Though technically challenging, excellent long-term graft viability and functional recovery can be achieved in the large majority of patients.

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“…12,13 Surgeons have utilized the free fibula transfer to reconstruct a myriad of humeral defects when nonvascularized bone graft or prosthesis would not be sufficient. [14][15][16] However, there conceivably exist circumstances where a free fibula flap is not an option, as in our shoulder arthrodesis case. Patients with multiple previous surgeries and attempts at wound coverage may have significant disruption of the regional vasculature.…”

Section: Discussionmentioning

confidence: 85%

Free Your Mind, Not Your Flap

Neusner

Pribaz

Guo

2022

Plastic and Reconstructive Surgery - Global Open

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Summary: The pedicled flap has been a mainstay of soft tissue reconstruction since the earliest days of plastic surgery. Advances in surgical technology and skill have led to an erosion in the use of pedicled flaps in favor of increasingly popular free tissue transfers. Still, regional flaps without microvascular anastomosis remain a valuable reconstructive tool. Although still requiring microsurgical skills, these flaps are of particular benefit in patients with few or poor quality recipient vessels, in those who cannot tolerate antiplatelet therapy, and in those who cannot tolerate the often-extended anesthesia time necessitated by microvascular anastomosis. Furthermore, pedicled flaps may significantly reduce total cost of a reconstruction procedure with similar outcomes. In this case series, we report challenging scenarios where microsurgical approaches may have been typical choices but were instead reconstructed by pedicled options with desired outcomes. Difficult soft tissue defects were successfully reconstructed with a variety of pedicled flaps. Soft tissue transfers to the abdomen, flank, shoulder, and back are presented. None of the reconstructions required microvascular anastomosis.

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Free fibula flap for humerus segmental reconstruction: report on 13 cases

Cited by 14 publications

References 35 publications

Effect of Anti-Infective Reconstituted Bone Xenograft Combined with External Fixator on Serum CRP and PCT Levels and Prognosis of Patients with Bone Infection after Lower Extremity Long Bone Trauma

Effect of Anti-Infective Reconstituted Bone Xenograft Combined with External Fixator on Serum CRP and PCT Levels and Prognosis of Patients with Bone Infection after Lower Extremity Long Bone Trauma

Surgical Outcomes, Complications, and Long-Term Functionality for Free Vascularized Fibula Grafts in the Pediatric Population: A 17-Year Experience and Systematic Review of the Literature

Free Your Mind, Not Your Flap

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