The outcome and complications of vascularised fibular grafts

Houdek, Matthew T.; Bayne, Christopher O.; Bishop, Allen T.; Shin, Alexander Y.

doi:10.1302/0301-620x.99b1.bjj-2016-0160.r1

Cited by 35 publications

(31 citation statements)

References 27 publications

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“…In the field of orthopedics, large bone defects are often encountered after comminuted fracture, bone infection, osteonecrosis, or tumor resection. In order to reconstruct such bone defects, a variety of methods have been employed including autogenous bone grafting [1], vascularized fibular transplantation [2], distraction osteogenesis [3], and artificial bone grafting using materials derived from calcium phosphate [4] or hydroxyapatite [5]. In particular, autogenous bone constitutes a superior material for reconstruction but exhibits some disadvantages such as limited amounts of harvestable material and concerns regarding donor sites [1,6].…”

Section: Introductionmentioning

confidence: 99%

Adipose-derived stem cell sheets accelerate bone healing in rat femoral defects

et al. 2019

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In the present study, we investigated whether both adipose-derived stem cell (ADSC) and osteogenic-induced ADSC sheets could promote bone healing in a rat distal femoral metaphysis bone defect model. A through-hole defect of 1 mm diameter was drilled into each distal femur of 12 week old rats. Forty-five rats were randomly assigned to three groups: (1) control group; (2) ADSC sheet group; or (3) osteogenic-induced ADSC sheet group. We evaluated each group by analysis of computerized tomography scans every week after the surgery, histological analysis, and DiI labeling (a method of membrane staining for post implant cell tracing). Radiological and histological evaluations showed that a part of the hole persisted in the control group at four weeks after surgery, whereas the hole was restored almost completely by new bone formation in both sheet groups. The mean value of bone density (in Houndsfield units) for the bone defect area was significantly higher in both sheet groups than that in the control group ( p = 0.05) at four weeks postoperative. A large number of osteocalcin positive osteoblasts were observed at the area of bone defect, especially in the osteogenic-induced ADCS sheet group. DiI labeling in the newly formed bone showed that each sheet had differentiated into bone tissue at four weeks after surgery. The ADSC and the osteogenic-induced ADSC sheets promoted significantly quicker bone healing in the bone defect. Moreover, the osteogenic-induced ADSC sheet may be more advantageous for bone healing than the ADSC sheet because of the higher number of osteocalcin positive osteoblasts via the transplantation.

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Section: Introductionmentioning

confidence: 99%

Adipose-derived stem cell sheets accelerate bone healing in rat femoral defects

et al. 2019

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“…In the recent large case study, the mean period for achieving bone union after the vascularized fibula graft was reported as 10 months. 11 Usually, it is considered that achieving bone union with the nonvascularized fibula graft is difficult in the present severe trauma case. Although angiography or bone scintigraphy was not performed after surgery to demonstrate the vascularization of the grafted fibula, we considered that the fibula flap remained vascularized.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Pre-Existing Deep Venous Thrombosis in the Peroneal Vein of a Free Osteocutaneous Fibula Flap

Hayashi

Kawamura

Maegawa

et al. 2018

J Reconstr Microsurg Open

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Background Deep venous thrombosis (DVT) of the lower leg is a widespread medical problem and is associated with hypercoagulable states. Although spontaneous thrombosis of the peroneal vein of a fibula flap is theoretically possible, few cases of asymptomatic DVT of the peroneal vein encountered during fibula flap harvest have been reported. Case Report A 45-year-old man presented with segmental bone defects of the tibia resulting from a fall. Treatment with a free vascularized osteocutaneous fibula flap from the contralateral lower leg was scheduled. Intraoperatively, diffuse thrombi were found in the peroneal venous system. After removal of thrombi, the fibula was grafted with anastomosis of the peroneal vessels to the recipient posterior tibial vessels. The skin paddle of the flap became congested after surgery; exsanguination of the skin paddle was performed with multiple skin incisions to relieve congestion. Despite treatment, the skin paddle became partially necrotic and additional skin grafting was performed. Bone union of the grafted fibula was achieved 5 months after initial surgery. Conclusions To the best of our knowledge, only six cases of pre-existing DVT in the peroneal vein of a free osteocutaneous fibula flap have been reported. In three of these cases, the fibula flap was successfully grafted. Although successful free osteocutaneous fibula flap surgery might be possible in patients with peroneal venous thrombosis, careful preoperative evaluation is recommended for high-risk patients.

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“…The vascularized free fibular bone graft is a type of autogenous bone graft and it was first described in 1975 by Taylor [24]. It is used in large bone defects, more than 5-6 cm [25]. The advantage of this method is the availability of bone stock, a faster union, less resorption of bone and lower fatigue fracture.…”

Section: Treatments For Bone Lesionsmentioning

confidence: 99%

“…This process involves a long surgical procedure and can increase the morbidity on the donor site. In addition, there is a demand for further information about the factors that lead to failure [25,26].…”

Section: Treatments For Bone Lesionsmentioning

confidence: 99%

Scaffolds and coatings for bone regeneration

Pereira

Cengiz

Silva

et al. 2020

J Mater Sci: Mater Med

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Bone tissue has an astonishing self-healing capacity yet only for non-critical size defects (<6 mm) and clinical intervention is needed for critical-size defects and beyond that along with non-union bone fractures and bone defects larger than critical size represent a major healthcare problem. Autografts are, still, being used as preferred to treat large bone defects. Mostly, due to the presence of living differentiated and progenitor cells, its osteogenic, osteoinductive and osteoconductive properties that allow osteogenesis, vascularization, and provide structural support. Bone tissue engineering strategies have been proposed to overcome the limited supply of grafts. Complete and successful bone regeneration can be influenced by several factors namely: the age of the patient, health, gender and is expected that the ideal scaffold for bone regeneration combines factors such as bioactivity and osteoinductivity. The commercially available products have as their main function the replacement of bone. Moreover, scaffolds still present limitations including poor osteointegration and limited vascularization. The introduction of pores in scaffolds are being used to promote the osteointegration as it allows cell and vessel infiltration. Moreover, combinations with growth factors or coatings have been explored as they can improve the osteoconductive and osteoinductive properties of the scaffold. This review focuses on the bone defects treatments and on the research of scaffolds for bone regeneration. Moreover, it summarizes the latest progress in the development of coatings used in bone tissue engineering. Despite the interesting advances which include the development of hybrid scaffolds, there are still important challenges that need to be addressed in order to fasten translation of scaffolds into the clinical scenario. Finally, we must reflect on the main challenges for bone tissue regeneration. There is a need to achieve a proper mechanical properties to bear the load of movements; have a scaffolds with a structure that fit the bone anatomy. Graphical Abstract* Helena Filipa Pereira

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The outcome and complications of vascularised fibular grafts

Cited by 35 publications

References 27 publications

Adipose-derived stem cell sheets accelerate bone healing in rat femoral defects

Adipose-derived stem cell sheets accelerate bone healing in rat femoral defects

A Rare Case of Pre-Existing Deep Venous Thrombosis in the Peroneal Vein of a Free Osteocutaneous Fibula Flap

Scaffolds and coatings for bone regeneration

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