Reconstruction of extremity long bone defects with vascularized fibula bone grafts

作     者：Corinne Wee DanieI Ruter Steven SchuIz Geoffroy Sisk JuIie West Scott TintIe Ian VaIerio Corinne Wee;Daniel Ruter;Steven Schulz;Geoffroy Sisk;Julie West;Scott Tintle;Ian Valerio

作者机构：Division of Plastic and Reconstructive Surgery in the Department of SurgeryCase Western Reserve UniversityClevelandOH 44106USA Division of Plastic and Reconstructive Surgery in the Department of SurgeryAlbany Medical CollegeAlbanyNY 12208USA Department of Plastic and Reconstructive SurgeryThe Ohio State UniversityColumbusOH 43212USA Department of Orthopaedic SurgeryWalter Reed National Military Medical CenterBethesdaMD 20889USA 

出 版 物：《Plastic and Aesthetic Research》 (整形与美容研究（英文版）)

年 卷 期：2019年第6卷第6期

页      面：1-12页

学科分类：1002[医学-临床医学] 1010[医学-医学技术（可授医学、理学学位）] 100215[医学-康复医学与理疗学] 10[医学] 

主　　题：Vascularized bone vascularized bone grafts composite extremity defect restoration bone reconstruction free tissue transfer microsurgery 

摘      要：Aim: Composite tissue defects encompassing bone and/or isolated bony defects can pose a surgical challenge;however, their reconstruction is critical for successful functional limb salvage. These cases become increasingly problematic as secondary defects, following multiple nonvascularized grafting attempts resulting in complex bony nonunion. Herein, our experience utilizing fibula vascularized bone grafts (VBGs) for bone restoration will be presented to demonstrate their utility in a variety of reconstructions for limb salvage. Methods: This is a case series describing a series of vascularized fibula grafts for extremity reconstruction performed by a single academic surgeon over multiple institutions in seven years. Results: Twenty-seven (27) total VBGs met inclusion criteria and underwent reconstruction for traumatic (16), oncologic (6) and chronic degenerative (5) etiologies. Bony union was achieved in 26 of 27 cases. Conclusion: The decision-making process for bony reconstruction in these scenarios is difficult and multivariable. Fibula VBGs can provide a single-stage solution for autologous bony and soft tissue replacement of large or complex bone defects and can often be superior options compared with non-vascularized bone grafts or non-bone internal fixation techniques. Their osteogenic potential is unmatched by allogenic or synthetic substitutions. These benefits are evident in a variety of clinical settings such as pediatrics, oncology and trauma.