Reconstruction of tibia defects by ipsilateral vascularized fibula transposition

Introduction Segmental defects of the tibia after open fractures, sepsis and tumor surgery present a challenging problem. Similarly, tumor surgery often involves radical resections and multiple procedures and is frequently accompanied by irradiation or chemotherapy creating an avascular bed. The aim of this study is to report the results and discuss the role of the ipsilateral pedicle vascularized fibula (IPVF) a technique used for reconstruction of tibia defects. Materials and methods Reconstruction of large tibia defects 6–22 cm due to tumor resection were performed in 5 patients by ipsilateral vascularized fibula transposition. The mean age of the patients was 35.4 years (19–42) SD 9.31. The mean follow-up was 59.6 months (24–96) SD 29.2. The mean length of the bone defect was 14.6 cm (6–22) SD 6.066 and the mean time for union was 8 months (6–12) SD 2.82. Arteriography was used preoperatively in all patients to evaluate the lower limb vasculature and to select the optimal surgical approach. The osteosynthesis was stabilized by a plate. Results There was sound union in all cases. There were only two minor complications one partial paresis of peroneal nerve and one superficial infection. The mean follow-up was 59.6 months (24–96) SD 29.2. No patient presented with any complaints with the procedure and all had good functional results. Conclusions The procedure was technically simple compared to free vascularized fibula and could be performed in hospital with low resources. There are several advantages: (a) achievement of bone defect reconstruction retaining periosteal and endosteal circulation, (b) preservation of a major vessel of the lower leg, (c) avoidance of difficulty and risk of microvascular technique and (d) no donor-morbidity. We routinely recommend preoperative angiography and intraoperatively meticulous dissection to prevent damage to the vascular pedicle.     

胫腓骨中下段骨折切开复位单侧外固定器治疗的体会

报告1994至1996年5月应用切开复位+Batiani型单边式外固定支架治疗胫腓骨中下段骨折34例,平均随诊1年6个月。无骨不愈合及固定失败,该支架对软组织创伤小,且固定可靠,能防止骨感染发生并有利于早期功能锻炼。     

Minimally invasive percutaneous plate osteosynthesis through fracture site approach for fracture of both tibia and fibula

Objective： To introduce the experience of treating fracture of both tibia and fibula with micro-invasive percutaneous plate internal fixation through fracture site approach. Methods： The data of 15 patients （11 males and 4 females）, including 14 adults （ aged 22-73 years, mean = 40 years） and 1 child （aged 10 years）, with fracture of both tibia and fibula were studied retrospectively in this study. A small incision was made at the fracture site of tibia. Then reposition was made under direct vision, and internal fixation was employed with steel plates inserting through the small incision. Results： Anatomical reduction was obtained. No complication was found. Union occurred on time in 14 patients. One case healed after a second operation. Conclusions ： Micro-invasive percutaneous plate internal fixation is beneficial to the healing of bone and soft tissues. Without X-ray examination, it is also easy to reach anatomical reduction and make tibial internal fixation with both plates with micro-invasive percutaneous plate internal fixation.     

吻合血管的游离复合皮瓣修复下颌骨及软组织缺损

目的　寻找一种既能同时满足修复下颌骨及软组织缺损需要 ,又符合牙种植条件的理想修复材料。方法　对 15例下颌骨复合组织缺损者行吻合血管的游离腓骨 -肌 -皮瓣复合组织移植修复。结果　 14例成功 ,颌面部外形、功能良好 ,利于牙种植。手术效果满意。结论　腓骨-肌 -皮瓣复合组织是目前修复下颌骨复合缺损的理想术式。     

带血管蒂肌瓣转移用于胫腓骨骨肉瘤保肢术

目的 报告四肢恶性肿瘤广泛切除保肢手术,应用带血管蒂肌瓣修复和重建软组织成功的经验。方法 广泛切除小腿骨肉瘤及瘤周软组织,得用人工假体或吻合血管游离腓骨和移植等方法重建骨骼,局部转移带血管蒂的腓骨肌或比目鱼肌肌瓣,欠组织缺损。结果 临床应用７例,带血管蒂的肌瓣成活良好,无切口并发症,膝关节活动度提高,假体表面皮肤移动性良好。结论 带血管蒂的肌瓣在胫腓骨恶性肿瘤的保肢术中,对于重建软组织缺损和保证切     

血管化游离腓骨肌皮瓣重建下颌骨缺损

目的：总结游离腓骨肌皮瓣修复下颌骨缺损的经验。方法：对25例应用游离腓骨肌皮瓣行下颌骨缺损修复的病例进行临床分析,探讨不同类型下颌骨缺损,所采用腓骨肌皮瓣的设计,复合组织瓣的成活情况及术后并发症的发生情况。结果：本组25例患者游离腓骨肌皮瓣成活率100%,最长的腓骨为16cm,分为三段者3例,两段者20例。结论：血管化的游离腓骨肌皮瓣修复下颌骨缺损血供丰富、抗感染力强、骨愈合快、塑形好、成活率高。     

全程使用与分阶段使用外固定架和石膏外固定治疗胫腓骨开放性骨折疗效比较

目的　探讨分阶段使用单侧多功能外固定架 (UMEFA )和石膏外固定治疗胫腓骨开放性骨折的疗效。方法　 89例胫腓骨开放性骨折经清创、骨折复位后均予以UMEFA外固定。然后 ,将其分 2组。A组 5 3例为全程骨外固定组 ,其中 8例因并发症较严重 ,中途拆除外固定架 ,其余 45例外固定维持至骨折愈合。B组 36例为临时骨外固定组 ,伤口愈合、肿胀消退、骨折纤维连接时拆除外固定架 ,改用长腿管状石膏外固定。结果　B组并发症的发生率为 8% ,显著低于A组40 % ( P <0 .0 1)。B组患者骨折愈合的平均时间为 2 13.6d ,显著低于A组 2 68.4d( P <0 .0 5 )。B组患者骨折愈合的优良率为 83% ,显著高于A组 60 % (P <0 .0 5 )。结论　分阶段使用外固定架和石膏外固定治疗胫腓骨开放性骨折 ,具有治疗效果好、骨折愈合快、并发症少等优点。     

单臂外固定支架配合跟骨牵引治疗胫腓骨粉碎性骨折

目的报告单臂外固定架配合跟骨牵引治疗胫腓骨粉碎性骨折的疗效。方法186例胫腓骨粉碎性骨折,其中开放骨折42例,闭合骨折142例,均采用单臂外固定架,配合跟骨牵引治疗。结果随访185例,183例骨愈合,平均愈合时间6个月,按Johner-Wrichs,优113例,良69例,差2例。针为17.5%。结论单臂外固定支架配合跟骨牵引治疗胫腓骨粉碎性骨折,方法,疗效肯定。     

筋膜皮瓣修复小腿开放性骨折并软组织缺损

1988年～1991年,用筋膜皮瓣修复胫脖骨开放性骨折并软组织缺损27例。一期闭合创面11例,延期创面修复16例,均获得较好的效果。筋膜皮瓣血运丰富,愈合力强,可以不受创面位置的限制,不牺牲知名血管,手术简单。对伤口周围软组织挫伤程度的正确估计,是选择一期或延期皮瓣转移的先决条件。     

吻合血管折叠式腓骨皮瓣修复大段胫骨及皮肤软组织缺损

目的报道采用吻合血管的折叠式腓骨皮瓣修复胫骨大段缺损伴骨外露的方法，并观察其临床疗效。方法采用吻合血管的折叠式腓骨皮瓣修复胫骨大段缺损伴骨外露5例。胫骨缺损6～10cm，皮肤软组织缺损范围4cm×5cm-7cm×18cm。保持骨膜的连续性，将腓骨截骨后折叠形成双管状腓骨皮瓣，移植修复胫骨及皮肤缺损。结果术后移植组织全部成活，皮瓣弹性、色泽良好，术后3—4个月患肢开始负重，术后随访8～10个月，复查X线片示腓骨与胫骨骨性愈合良好，恢复行走功能。结论吻合血管的折叠式腓骨皮瓣修复胫骨大段缺损伴骨外露及皮肤软组织缺损是可靠、有效的治疗方法，值得临床推广应用。     

改良腓骨皮瓣交叉移植治疗感染性胫骨骨及皮肤缺损

隙通道的改良腓骨皮瓣交叉移植一期修复胫骨感染性骨及皮肤缺损,方法安全可靠、成功率高,体位舒适,是保肢的有效方法.     

There is no donor side specificity of fibula free flap for complex oromandibular reconstruction

Background:

The objective of this study was to prove that there is no significance to the donor side (right or left) of the free fibula osteocutaneous flap (FFOCF) in the reconstruction of complex oromandibular defects (COMD) and proper flap planning, designing and tailoring are important in reconstructing different types of COMD after tumour-ablative surgery.

Materials and Methods:

Three hundred and eighty-six consecutive patients who where reconstructed with FFOCF for COMD from Jan 2005 to Dec 2009 over a period of 5 years were studied. Except in seven patients, all fibula flaps were harvested from the left leg as per convenience and to facilitate a simultaneous, two-team approach. Depending on the condition of the neck vessels, vascular anastomosis was performed on the right or the left side, irrespective of the side of the defect.

Results:

Complete flap survival was seen in 334 patients (86.52%). Superficial skin necrosis was seen in 20 patients, and was managed conservatively (5.18%). Partial flap loss was seen in 20 patients (5.18%). There were 39 re-explorations. Complete flap loss was seen in 12 patients (3.10%).

Conclusion:

We found no significance in terms of the results as far as the side of flap donor leg or primary defect were concerned. Flap tailoring in terms of meeting the tissue requirement and vessel orientation were rather more important.     

The longitudinally split vascularized fibula with a vascularized periosteal flap for the reconstruction of large segmental bone defects of the tibia

Summary A new principle in reconstructive surgery is presented: The immediate reconstruction of a missing bone segment with a primary osteoperiosteal tube that will secondarily be transformed into a complete osseous tube. In 5 out of 7 baboons, a bone tube with an almost normal bone cavity was achieved after 16 to 28 weeks. In 2 cases, we failed to reconstruct the tube because of an intraoperative fault and postoperative plate fracture with subsequent destruction of the vascularized periosteal flap. On the basis of this study, we describe a new concept in reconstruction of segmental bone defects of the lower extremity. The osteoperiosteal tube is formed by the combination of two successful experimental and clinical techniques: the vascularized fibular transfer which is modified by splitting the bone graft longitudinally, and transfer of vascularized periosteum (concept of the substitution of a missing bone segment by an organ-like tube). In the most stressed marginal region of the bone defect, there is vascularized cortical bone from the longitudinally split fibular graft and an increasing amount of lamellar bone being produced under the vascularized periosteal flap. By splitting the graft, nutrition depends entirely on the periosteal blood supply. The concept of the dual blood supply was initially described by Berggren et al. and Papanastasiou et al. [4, 18]. The significance of the concept of the vascularized periosteum transfer for reconstruction of a segmental bone defect is well illustrated. Only in cases where the vascularized periosteal flap was intact and securely sutured to the fibulae graft and the two tibia stumps could a bone tube be reconstructed. The arrangement of both vascularized grafts as an osteoperiosteal tube exemplify the concept of the given space as described by Stock et al. [26]. Inside the osteoperiosteal tube, a consolidation chamber is created in which all the factors required for bone formation can be concentrated. Comparison of the results of successfully reconstructed bone tubes with the solid bone column in the defect of the baboon where no bone tube could be reconstructed underline the concept of combination of different vascularized grafts for reconstruction of segmental bone defects in long bone defects of the lower extremity.This work was presented at the 5th German-Austrian-Swiss Congress of Traumatology in Berlin in November of 1987. The part of vascularity analysis was supported by a grant from the Friedrich-Baur-Stiftung     

游离腓骨骨皮瓣加单臂外固定架治疗胫骨骨缺损

目的 探讨游离腓骨骨皮瓣治疗胫骨骨缺损的方法和临床疗效.方法 采用吻合血管的游腓骨骨皮瓣移植加单臂外固定架治疗12例因创伤、慢性骨髓炎导致的胫骨骨缺损患者.结果 患者腓骨骨皮瓣携带皮岛血运均良好,切口均一期愈合.12例均获随访,时间12~48个月.全部骨性愈合,患者恢复行走功能.结论 吻合血管的游离腓骨骨皮瓣移植加单臂外固定架治疗胫骨骨缺损临床疗效满意.     

胫腓骨骨折治疗中固定腓骨的意义

2001年1月～2005年1月,我科手术治疗胫腓骨粉碎性骨折患者54例,报道如下. 1 材料与方法 1.1 病例资料本组54例,男37例,女17例,年龄18～60岁.分为两组.     

The ortho-plastic management of Gustilo grade IIIB fractures of the tibia in children: A systematic review of the literature

Background

The challenges of managing Gustilo IIIB tibial fractures in children are unique. A multi-disciplinary, evidence based approach is needed. We aimed to evaluate the evidence for the ortho-plastic management of Gustilo grade IIIB open tibial shaft fractures in children based on a review of all published data in order to rationalise the orthopaedic and plastic surgical approach to these complex injuries.

Method

A systematic review of the literature was performed. Gustilo grade IIIB tibial shaft fractures in pre-adolescent and adolescent children were identified and evaluated with regard to both the skeletal and soft tissue management, and the outcome.

Results

Of 54 children with grade IIIB tibial fractures, a mean union time of 31 weeks included 33 weeks for 42 adolescents and 23 weeks for 12 pre-adolescents. Faster union time in pre-adolescents tended towards significance. Delayed union occurred in 22%, nonunion in 13%, mostly in adolescents. Two of 45 covered by vascularised flaps and 3 of 9 treated without flaps developed deep infection (p = 0.028). There was no correlation between method of skeletal fixation and union time.

Conclusion

Gustilo IIIB tibial shaft fractures in pre-adolescents tended towards faster healing with fewer complications, irrespective of the method of skeletal fixation. In adolescents, healing times were similar to adults. Soft tissue closure without flaps was associated with deep infection in one-third of patients, requiring debridement and flap cover. Adequate debridement and flap cover is suggested in all cases, irrespective of age.