New Options for Vascularized Bone Reconstruction in the Upper Extremity

Houdek, Matthew T.; Wagner, Eric R.; Wyles, Cody C.; Nanos, George P.; Moran, Steven L.

doi:10.1055/s-0035-1544167

Cited by 45 publications

(41 citation statements)

References 101 publications

(182 reference statements)

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“…The current “gold standard” for the repair of CSD defects is autologous vascularized bone grafting, which is limited by the lack of viable donor sites coupled with potential donor site morbidity . Such limitations have been the driving force to the exploration of other potential modalities including 3D‐printed scaffolds.…”

Section: Discussionmentioning

confidence: 99%

“…Several challenges the patient may experience include finding the appropriate treatment modality, cost of care, disability, and the psychosocial impact of the aforementioned . For defects greater than 5–6 cm in size, autologous vascularized bone transfer remains the “gold standard” reconstructive treatment option . Although bone flaps have demonstrated excellent outcomes, limitations persist in the form of number of viable donor sites, donor site morbidity, surgical site infection, and delayed healing.…”

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confidence: 99%

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Repair of Critical‐Sized Long Bone Defects Using Dipyridamole‐Augmented 3D‐Printed Bioactive Ceramic Scaffolds

Witek

Alifarag

Tovar

et al. 2019

Journal Orthopaedic Research

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There are over two million long bone defects treated in the United States annually, of which~5% will not heal without significant surgical intervention. While autogenous grafting is the standard of care in simple defects, a customized scaffold for large defects in unlimited quantities is not available. Recently, a three-dimensionally (3D)-printed bioactive ceramic (3DPBC) scaffold has been successfully utilized in the of repair critical-sized (CSD) long bone defects in vivo. In this study, 3DPBC scaffolds were augmented with dipyridamole (DIPY), an adenosine A2A receptor (A 2A R) indirect agonist, because of its known effect to enhance bone formation. CSD full thickness segmental defects (~11 mm × full thickness) defects were created in the radial diaphysis in New Zealand white rabbits (n = 24). A customized 3DPBC scaffold composed of β-tricalcium phosphate was placed into the defect site. Groups included scaffolds that were collagen-coated (COLL), or immersed in 10, 100, or 1,000 μM DIPY solution. Animals were euthanized 8 weeks post-operatively and the radii/ulna-scaffold complex retrieved en bloc, for micro-CT, histological, and mechanical analysis. Bone growth was assessed exclusively within scaffold pores and evaluated by microCT and advanced reconstruction software. Biomechanical properties were evaluated utilizing nanoindentation to assess the newly regenerated bone for elastic modulus (E) and hardness (H). MicroCT reconstructions illustrated bone in-growth throughout the scaffold, with an increase in bone volume dependent on the DIPY dosage. The histological evaluation did not indicate any adverse immune response while revealing progressive remodeling of bone. These customized biologic 3DPBC scaffolds have the potential of repairing and regenerating bone.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Repair of Critical‐Sized Long Bone Defects Using Dipyridamole‐Augmented 3D‐Printed Bioactive Ceramic Scaffolds

Witek

Alifarag

Tovar

et al. 2019

Journal Orthopaedic Research

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“…The vascularized fibula free flap is indicated for long bony defects of the radius, ulna, and humerus. [42][43][44][45] It is similar in shape and length to the diaphysis of the radius and ulna, making it ideal for reconstruction. 42,44 The vascular supply of the fibula is from the peroneal artery which branches from the tibioperoneal trunk distal to the takeoff of the anterior tibial artery.…”

Section: Functional Tissue Transfermentioning

confidence: 99%

Free Tissue Transfer for Upper Extremity Reconstruction

Dibbs

Grome

Pederson

2019

Seminars in Plastic Surgery

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With the advent of the Industrial Revolution, traumatic injuries of the upper extremity increased exponentially. As a result, surgeons began to reevaluate amputation as the standard of care. Following the Second World War, local and regional pedicled flaps became common forms of traumatic upper extremity reconstruction. Today, microsurgery offers an alternative when options lower on the reconstructive ladder have been exhausted or will not produce a desirable result. In this article, the authors review the use of free tissue transfer for upper extremity reconstruction. Flaps are categorized as fasciocutaneous, muscle, and functional tissue transfers. The thin pliable nature of fasciocutaneous flaps makes them ideal for aesthetically sensitive areas, such as the hand. The radial forearm, lateral arm, scapula, parascapular, anterolateral thigh, and temporoparietal fascia flaps are highlighted in this article. Muscle flaps are utilized for their bulk and size; the latissimus dorsi flap serves as a “workhorse” free muscle flap for upper extremity reconstruction. Other muscle flaps include the rectus abdominis and serratus anterior. Lastly, functional tissue transfers are used to restore active range of motion or bony integrity to the upper extremity. The innervated gracilis can be utilized in the forearm to restore finger flexion or extension. Transfer of vascularized bone such as the fibula may be used to correct large defects of the radius or ulna. Finally, replacement of “like with like” is embodied in toe-to-thumb transfers for reconstruction of digital amputations.

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“…In the upper extremity, bone defects greater than 6 cm, both resulting from oncological resections or traumatic injuries usually require a vascularized bone transfer, especially if there is risk of infection. The free fibula flap is ideal for reconstruction of the long bones of the arm, due to its characteristics and shape [91][92][93] . Its harvest presents low donor site morbidity, mostly represented by flexion contracture of the great toe and ankle pain [94][95][96] .…”

Section: Bone Reconstructionmentioning

confidence: 99%

Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

Bolletta¹,

Rubino²,

Chen³

2019

PAR

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In the recent decades, microsurgical reconstruction has evolved from simple survival of the affected extremity to the improvement of functional and aesthetic outcome. This review retraces the main contributions to the advances of microsurgery for reconstruction of upper and lower extremities and limb preservation. In the upper extremity, it is important to restore fine motility, together with allowing prompt mobilization. In the lower limb, care must be taken in the reconstruction of weight-bearing areas and the aim must be proper ambulation and shoe wearing. Local perforator flaps can be considered for medium size defects. They provide thin coverage and can be performed in short operating time. Their use, though, is often limited by tissue availability. Free flaps allow to overcome this problem and, thanks to the recent development in the study of perforator vessels, the microsurgeon can choose the flap with the most appropriate characteristics. Chimeric flaps can accomplish simultaneous reconstruction of different tissue components and large bone defects often require vascularized bone reconstruction. When dealing with limb preservation it is very important to consider residual functionality. Functioning muscle transfer and targeted muscle re-innervation can be performed in these cases. A useful reconstructive tool in severely damaged limbs with limited blood supply is the use of cross-leg free flaps. In conclusion, extremity reconstruction and limb preservation are reaching new heights thanks, not only to the work of plastic surgeons, but also to the new developments in other fields of study such as oncology, traumatology, radiology and medical engineering.

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New Options for Vascularized Bone Reconstruction in the Upper Extremity

Cited by 45 publications

References 101 publications

Repair of Critical‐Sized Long Bone Defects Using Dipyridamole‐Augmented 3D‐Printed Bioactive Ceramic Scaffolds

Repair of Critical‐Sized Long Bone Defects Using Dipyridamole‐Augmented 3D‐Printed Bioactive Ceramic Scaffolds

Free Tissue Transfer for Upper Extremity Reconstruction

Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

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