Use of the Vascularized Free Fibula Graft with an Arteriovenous Loop for Fusion of Cervical and Thoracic Spinal Defects in Previously Irradiated Pediatric Patients

Jandali, Shareef; DiLuna, Michael L.; Storm, Phillip B.; Low, David W.

doi:10.1097/prs.0b013e31820cf4a6

Cited by 23 publications

(24 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…At present, the most effective method for treating bone defect is autologous bone grafting carrying blood vessel. 8,9 This method can prevent bone graft to be absorbed and could reconstruct blood supply permanently, but there are also some disadvantages related to this strategy including inadequate bone resource, limited bone shape, inducing some damage in the donor area, etc. It is to note that autologous bone grafting carrying blood vessel cannot repair the large bone defect.…”

Section: Introductionmentioning

confidence: 99%

Tantalum coating of porous carbon scaffold supplemented with autologous bone marrow stromal stem cells for bone regenerationin vitroandin vivo

Wei

Zhao

Wang

et al. 2016

Exp Biol Med (Maywood)

View full text Add to dashboard Cite

Porous tantalum metal with low elastic modulus is similar to cancellous bone. Reticulated vitreous carbon (RVC) can provide threedimensional pore structure and serves as the ideal scaffold of tantalum coating. In this study, the biocompatibility of domestic porous tantalum was first successfully tested with bone marrow stromal stem cells (BMSCs) in vitro and for bone tissue repair in vivo. We evaluated cytotoxicity of RVC scaffold and tantalum coating using BMSCs. The morphology, adhesion, and proliferation of BMSCs were observed via laser scanning confocal microscope and scanning electron microscopy. In addition, porous tantalum rods with or without autologous BMSCs were implanted on hind legs in dogs, respectively. The osteogenic potential was observed by hard tissue slice examination. At three weeks and six weeks following implantation, new osteoblasts and new bone were observed at the tantalum-host bone interface and pores. At 12 weeks postporous tantalum with autologous BMSCs implantation, regenerated trabecular equivalent to mature bone was found in the pore of tantalum rods. Our results suggested that domestic porous tantalum had excellent biocompatibility and could promote new bone formation in vivo. Meanwhile, the osteogenesis of porous tantalum associated with autologous BMSCs was more excellent than only tantalum implantation. Future clinical studies are warranted to verify the clinical efficacy of combined implantation of this domestic porous tantalum associated with autologous BMSCs implantation and compare their efficacy with conventional autologous bone grafting carrying blood vessel in patients needing bone repairing.

show abstract

Section: Introductionmentioning

confidence: 99%

Tantalum coating of porous carbon scaffold supplemented with autologous bone marrow stromal stem cells for bone regenerationin vitroandin vivo

Wei

Zhao

Wang

et al. 2016

Exp Biol Med (Maywood)

View full text Add to dashboard Cite

show abstract

“…Lengthening with additional microanastomosis is a classical procedure. Vein grafting is also a conventional and useful technique (Flores, Rad, Shridharani, Stapleton, & Rosson, ; Karanas, Yim, Johannet, Hui, & Lineaweaver, ), and the vascular loop technique (Jandali, Diluna, Storm, & Low, ; Lind, McCarthy, Derman, & Jacobs, ) and arteriovenous interposition grafting (Echo & Bullocks, ; Zenn, Pribaz, & Walsh, ) is a modification of conventional vein grafting. Other new procedures are based on using the natural vascular branching pattern of the subscapular vascular tree (Usami, Okazaki, Tanaka, Homma, & Yano, ) or branches of the ALT flap (Huang, Hsieh, Lai, Lin, & Chang, ).…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of severe atherosclerotic and obstructive diabetic feet using thoracodorsal artery perforator flaps with long vascular pedicles

2017

View full text Add to dashboard Cite

show abstract

“…However, it should be considered that complication rates for this procedure are relatively high, and should be weighed against the potential benefit. 1,27,36,41,48,67 For instance, Minami et al 47 reported that the procedure had to be abandoned in 3 of 16 patients because of difficulties with microsurgical anastomosis. Also, the mean ± standard deviation time needed for the harvest, rib preparation, and anastomosis was 58 ± 13 minutes.…”

Section: Discussionmentioning

confidence: 99%

“…58,62,63,66 Because of these issues, it is unclear what bone graft options should be selected in patients with spinal column tumors. The literature is also significantly limited, as a majority of prior reports were either retrospective with small numbers of patients, 1,36 or case reports, 5 focusing on survival outcomes or technical aspects of surgery rather than fusion outcomes. 73 To the best of our knowledge, this is the first systematic review and meta-analysis focusing solely on bone graft options and fusion rates in the setting of spinal column tumor resection, aiming to provide some clinical insight into this controversial issue.…”

mentioning

confidence: 99%

Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis

Elder

Ishida

Goodwin

et al. 2017

FOC

View full text Add to dashboard Cite

OBJECTIVE With the advent of new adjunctive therapy, the overall survival of patients harboring spinal column tumors has improved. However, there is limited knowledge regarding the optimal bone graft options following resection of spinal column tumors, due to their relative rarity and because fusion outcomes in this cohort are affected by various factors, such as radiation therapy (RT) and chemotherapy. Furthermore, bone graft options are often limited following tumor resection because the use of local bone grafts and bone morphogenetic proteins (BMPs) are usually avoided in light of microscopic infiltration of tumors into local bone and potential carcinogenicity of BMP. The objective of this study was to review and meta-analyze the relevant clinical literature to provide further clinical insight regarding bone graft options. METHODS A web-based MEDLINE search was conducted in accordance with preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines, which yielded 27 articles with 383 patients. Information on baseline characteristics, tumor histology, adjunctive treatments, reconstruction methods, bone graft options, fusion rates, and time to fusion were collected. Pooled fusion rates (PFRs) and I2 values were calculated in meta-analysis. Meta-regression analyses were also performed if each variable appeared to affect fusion outcomes. Furthermore, data on 272 individual patients were available, which were additionally reviewed and statistically analyzed. RESULTS Overall, fusion rates varied widely from 36.0% to 100.0% due to both inter- and intrastudy heterogeneity, with a PFR of 85.7% (I2 = 36.4). The studies in which cages were filled with morselized iliac crest autogenic bone graft (ICABG) and/or other bone graft options were used for anterior fusion showed a significantly higher PFR of 92.8, compared with the other studies (83.3%, p = 0.04). In per-patient analysis, anterior plus posterior fusion resulted in a higher fusion rate than anterior fusion only (98.8% vs 86.4%, p < 0.001). Although unmodifiable, RT (90.3% vs 98.6%, p = 0.03) and lumbosacral tumors (74.6% vs 97.9%, p < 0.001) were associated with lower fusion rates in univariate analysis. The mean time to fusion was 5.4 ± 1.4 months (range 3–9 months), whereas 16 of 272 patients died before the confirmation of solid fusion with a mean survival of 3.1 ± 2.1 months (range 0.5–6 months). The average time to fusion of patients who received RT and chemotherapy were significantly longer than those who did not receive these adjunctive treatments (RT: 6.1 months vs 4.3 months, p < 0.001; chemotherapy: 6.0 months vs 4.3 months, p = 0.02). CONCLUSIONS Due to inter- and intrastudy heterogeneity in patient, disease, fusion criteria, and treatment characteristics, the optimal surgical techniques and factors predictive of fusion remain unclear. Clearly, future prospective, randomized studies will be necessary to better understand the issues surrounding bone graft selection following resection of spinal column tumors.

show abstract

Use of the Vascularized Free Fibula Graft with an Arteriovenous Loop for Fusion of Cervical and Thoracic Spinal Defects in Previously Irradiated Pediatric Patients

Abstract: The free fibula flap is ideally suited for accelerated posterior spinal fusion after extensive resection of cervical or thoracic spinal neoplasms. An arteriovenous saphenous vein loop facilitates the microvascular anastomosis in this anatomical region that lacks suitable recipient vessels.

Cited by 23 publications

References 22 publications

Tantalum coating of porous carbon scaffold supplemented with autologous bone marrow stromal stem cells for bone regenerationin vitroandin vivo

Tantalum coating of porous carbon scaffold supplemented with autologous bone marrow stromal stem cells for bone regenerationin vitroandin vivo

Reconstruction of severe atherosclerotic and obstructive diabetic feet using thoracodorsal artery perforator flaps with long vascular pedicles

Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis

Contact Info

Product

Resources

About