Pathologic fracture of the proximal ulna through a bone graft donor site

Complications of harvesting autologous bone graft from the iliac crest and tibia are well known; exclusive use of upper extremity donor sites in hand surgery has therefore been advocated. Six weeks of postoperative elbow splinting has been recommended after harvest of large proximal ulnar grafts. We report two cases of pathologic fracture of the proximal ulna complicating local bone grafting and question whether the risk of fracture and the attendant patient inconvenience and potential joint stiffness incurred by postoperative immobilization are exceeded by the morbidity of carefully done iliac crest grafting.     

Ankle instability of the donor site following removal of vascularized fibula bone graft

We have assessed the donor site of fibula bone graft to detect signs and symptoms of ankle instability in 8 patients. In 1 patient with generalized joint hyperlaxity pain, clinical instability and pathological motion of the proximal end of the distal remaining fibula were encountered. Seven other patients were asymptomatic and had no instability both clinically and on stress radiographs.     

Fracture and herniation of bowel at bone graft donor site in the iliac crest

Fracture at a bone graft donor site in the iliac crest is an uncommon but documented occurrence. Herniation at this site requires a deep dehiscence of the wound, and is rare. A patient is reported with complete wound dehiscence in association with a fracture at a bone graft donor site in the iliac crest.     

Sciatic nerve palsy caused by haematoma from iliac bone graft donor site

Summary A 27-year-old woman developed a haematoma-related compressive neuropathy of the right sciatic nerve following the harvesting of a bone graft from the posterior aspect of the right iliac crest. The nerve was compressed in an enclosed compartment between the sciatic notch and the piriformis muscle, which is thought to be involved in the piriformis syndrome. The symptoms improved once the haematoma was evacuated, and this complication stresses the importance of adequate haemostasis of the area from which the bone graft is taken.     

The split calvarial bone graft donor site: the effects of surgicel and hydroxyapatite impregnated with collagen

Surgicel, which is commonly used as a hemostatic agent in clinical practice, is basically composed of oxidized regenerated cellulose. Skoog followed by Thilander and Stenstrom are credited with initially describing the use of Surgicel as a subperiosteal implant that could stimulate new bone formation in the closure of secondary palatal fistulae. Encouraged by these previous studies, we decided to investigate the effect of Surgicel and a new implant material, hydroxyapatite impregnated with collagen, on the split calvarial bone graft donor site. To do this, we used adult New Zealand White rabbits as our experimental model. Our study demonstrated histological evidence of both an increased quantity and earlier bony reformation, eventually reconstituting the surgical defect in the split calvarial bone graft donor site treated with Surgicel. Additionally, we found that this alloplastic implant material has potential in the reconstruction of the donor defect in selected patients.     

A prospective comparison of two split-skin graft donor site dressings

Adjacent split-skin graft donor sites were dressed with polyurethane foam (Lyofoam) and the occlusive dressing normally used in this unit. The findings are discussed.     

Subjective recovery of nerve graft donor site

Nerve graft procedures require the use of a donor nerve to supply the graft material. This results in an area of numbness in a less critical region. The purpose of this study was to assess donor site recovery using patient subjective evaluation. Thirty-one patients (mean age, 38 years) who were at least 2 years past a nerve graft procedure participated in the telephone survey. The mean time since surgery was 65 months. Donor nerves from the lower extremity were utilized in 16 patients and from the upper extremity in 15 patients. The subjective patient evaluations indicated low levels of pain, numbness, and cold sensitivity in the donor nerve sensory distribution. Patient factors, including workers' compensation and legal involvement, did not have a significant effect on recovery at the donor site. Function and daily activity were not affected significantly by donor site factors. Satisfaction with nerve graft recovery was related significantly to reported patient satisfaction of the donor site (p = 0.002).     

Calvarial bone graft donor site: a histological study in a rabbit model

Recently the calvarium has become a popular site for harvesting bone grafts because of its low incidence of morbidity, its proximity to the operative site, and the decreased amount of resorption as a result of its membranous nature. However, information regarding the phenomenon of repair at the donor site itself remains lacking. This investigation was initiated in 40 adult white New Zealand rabbits as an experimental model to study the process of repair at the donor site and to examine the possible use of hydroxyapatite to reconstruct the residual donor site deformity. Our experimental protocol closely followed our clinical procedure for the harvesting of split calvarial bone grafts. Our conclusions in the rabbit model were: (1) each of the commonly used hemostatic agents (bone wax and gelfoam) inhibit osteoneogenesis to varying degrees, (2) hydroxyapatite shows promise in the reconstruction of the donor site defect, and (3) if the periosteum comes in direct contact the defect repairs itself.     

Cancellous bone donor site regeneration

Patients requiring cancellous bone grafting of an extensive deficit or multiple grafting procedures often lack a sufficient quantity of autogenous cancellous donor bone. This study was designed to determine the potential for reharvesting autogenous cancellous bone donor sites in a canine model. Fixed-sized cancellous bone grafts were harvested from the ilium of 12 mature, conditioned dogs. Ilia containing the donor sites were removed from groups of 3 dogs at intervals of 6 weeks, 3 months, 6 months, and 1 year. The donor sites were evaluated by roentgenograms, histology, and histomorphometric analysis and were compared to the opposite, nonoperated ilia, which served as controls. The analysis revealed a gradual replacement of the surgical defect with new cancellous bone by 1 year. Donor site reharvesting is a potential alternative to multiple site grafting or the use of allograft material.     

Morbidity at bone graft donor sites

A review of the medical records of 239 patients with 243 autogenous bone grafts was undertaken to document the morbidity at the donor sites. The overall major complication rate was 8.6%. Major complications included infection (2.5%), prolonged wound drainage (0.8%), large hematomas (3.3%), reoperation (3.8%), pain greater than 6 months (2.5%), sensory loss (1.2%), and unsightly scars. Minor complications (20.6%) included superficial infection, minor wound problems, temporary sensory loss, and mild or resolving pain. There was a much higher complication rate (17.9% major) if the incision used for the surgery was also the same incision used to harvest the bone graft.     

Fractures at cancellous bone graft donor sites

Two cases of fracture, which followed removal of bone for grafting are presented. One affected the femur and one the ilium. The implications of this complication are discussed.     

缝合打包跨供区加压法植皮修复皮瓣移植供区创面

目的探讨缝合打包跨供区加压法植皮修复皮瓣移植供区创面的手术方法和临床疗效。方法应用缝合打包跨供区加压改良植皮方法修复皮瓣转移供区皮肤缺损48例,其中手指岛状皮瓣移植供区创面17例,手背皮瓣移植供区7例,前臂皮瓣移植供区10例,足部皮瓣移植供区创面6例,小腿皮瓣移植供区创面8例。供区创面1.5 cm×1.0 cm~18.0 cm×15.0 cm。急诊手术26例,均为创伤性皮肤软组织缺损行皮瓣转移术供区创面;择期手术22例,肿物切除创面行皮瓣转移修复术供区8例,瘢痕切除创面行皮瓣转移术供区10例,肢(指)体坏死解脱后创面行皮瓣修复术供区4例。结果 48例植皮及皮瓣全部成活,45例获得6~29个月的随访,供区植皮质地柔软,外观饱满,无色素沉着及摩擦溃疡瘢痕,两点辨别觉达8~13 mm,平均10.8 mm,肢体功能恢复满意。结论缝合打包跨供区加压法植皮修复皮瓣转移供区创面,手术简便、安全,植皮成活率高,术后外形满意,是一种较为实用的方法。     

Possible metastasis of osteosarcoma to a remote biopsy site: a case report

In a patient who presented with an osteosarcoma of the proximal humerus, systemic staging revealed a lesion in the contralateral humerus, which was shown to be an enchondroma after open biopsy. The patient had a local recurrence develop, which necessitated forequarter amputation. Shortly thereafter, the patient had pain develop at the contralateral biopsy site, and examinations and repeat biopsy revealed metastatic osteosarcoma. We think it is likely that surgical trauma contributed to the development of this unusual metastasis. In this clinical situation, consideration should be given to doing the biopsy and definitive resection on separate occasions.