SALVAGE OF THE LIMB WITH CRITICAL SIZE BONE DEFECT USING FREE VASCULARIZED FIBULA

  • P. CIOBANU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • V. POROCH “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Natalia VELENCIUC “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • B. VELICEASA “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Abstract

The critical bone defect is not yet well defined, but it is well known that the free vascularized fibula (FLAP) transfer represents the gold standard in the reconstruction of complex bone defects associated with other soft parts defects, both post-traumatic and belonging to other etiologies. Material and methods: We will be presenting a lot consisting of three male patients, that in regard to the wounds caused by an accident with industrial machines involved, were diagnosed with forearm-localized type III C Gustilo-Anderson open fractures, and residually displayed radius defects across a length of 10-12 centimeters, which required us to opt for free vascularized fibula transfer with cutaneous island, in all three cases. Results: The results were good in all cases. Within one single case the cutaneous island displayed a discreet venous congestion which demanded the use of leeches, and eventually turning out very well. Conclusions: The treatment of the critical bone defects required ample, microsurgical interventions performed in multidisciplinary teams, the autologous bone remaining the best option for bone reconstruction, being the best growth factor and bone stimuli source, with no immunological modifications or risk of disease transmission.

Author Biographies

P. CIOBANU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Surgery (I)
“Sf. Spiridon” County Clinical Emergency Hospital, Iasi, Romania
Clinic of Plastic Surgery and Reconstructive Microsurgery

V. POROCH, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Surgery (I)
Regional Institute of Oncology Iasi, Romania, Palliative Care

Natalia VELENCIUC, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Surgery (I)

B. VELICEASA, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Surgery (II)
“Sf. Spiridon” County Clinical Emergency Hospital, Iasi, Romania
Clinic of Orthopedics and Traumatology

References

1. Nauth A, McKee MD, Einhorn TA, et al. Managing bone defects. J Orthop Trauma. 2011; 25: 462-466.
2. Schemitsch, Emil H. MD, Size Matters, Defining Critical in Bone Defect Size! J Orthop Trau-ma: 2017; 31: 20-22.
3. Pertea M, Velenciuc N, Grosu O, Veliceasa B, Poroch V, Lunca S. Reconstruction of heel soft tissue defect s using sensate medial plantar flap. J Mind Med Sci JMMS 2018; 52: 250-254.
4. Sanders DW, Bhandari M, Guyatt G, et al. Critical-sized defect in the tibia: is it critical? Results from the SPRINT trial. J Orthop Trauma 2014; 28: 632-635.
5. Sen MK, Miclau T. Autologous iliac crest bone graft: should it still be the gold standard for treating nonunions? Injury 2007; 38(suppl 1): S75-S80.
6. Fowler BL, Dall BE, Rowe DE. Complications associated with harvesting autogenous iliac bone graft. Am J Orthop Belle Mead NJ 1995; 2412: 895-903.
7. Jacobson JHI, Suarez EL, Microsurgery in anastomosis of small vessels. Surg Forum 1960; 11: 243-245.
8. Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg 1975; 555: 533-544.
9. Nidal F. AL Deek, Huang-Kai Kao, Fu-Chan Wei. The Fibula Osteoseptocutaneous Flap: Concise Review, Goal-Oriented Surgical Technique, Tips and Tricks Plast Reconstr Surg 2018; 142: 913e
10. Weiland AJ, Moore JR, Daniel RK. Vascularized bone autografts. Experience with 41 cases. Clin Orthop Relat Res 1983; 174: 87-95.
11. Alexa O, Pertea M, Puha B, Popescu D, Gheorghevici S, Veliceasa B. Free Vascularized Fibular Bone Graft, a Reliable Method for the Management of Large Skeletal Defects in Orthopedic Trauma. Journal of Surgery 2016; 124: 173-176.
12. Harii K. Microvascular Tissue Transfer. Fundamental Techniques and Clinical Applications. Tokyo: Igaku-Shoin, 1983, 157-176.
13. Taylor GI. The current status of free vascularized bone grafts. Clin Plast Surg 1983; 101: 185-209.
14. McClure PK, Alrabai HM, Conway JD. Preoperative Evaluation and Optimization for Reconstruction of Segmental Bone Defects of the Tibia. J of Orthop Trauma 2017; 31: S16-S19.
15. Han CS, Wood MB, Bishop AT, Cooney WP 3rd. Vascularized bone transfer. J Bone Joint Surg Am 1992; 7410: 1441-1449.
16. Minami A, Kaneda K, Itoga H. Treatment of infected segmental defect of long bone with vascularized bone transfer. J Reconstr Microsurg 1992; 82: 75-82.
17. Tu YK, Yen CH, Yeh WL, et al. Reconstruction of posttraumatic long bone defect with free vascular-ized bone graft: good outcome in 48 patients with 6 years’ follow-up. Acta Orhop Scand 2001; 72: 359-364.
18. Yajima H, Tamai S, Ono H, Kizaki K, Yamauchi T. Free vascularized fibula grafts in surgery of the upper limb. J Reconstr Microsurg 1999; 15: 515-521.
19. Minami A, Kaneda K, Itoga H. Treatment of infected segmental defect of long bone with vascularized bone transfer. J Reconst rMicrosurg 1992; 82: 75-82.
20. Pertea M, Velencic N, Poroch V, et al. Efficacy of negative pressure therapy NPWT) in the manage-ment of wounds of different etiologies. Rev Chim 2018; 698: 1980-1986.
21. González delPino J, Knapp K, Gómez Castresana F, Benito M. Revascularization of femoral head ischemic necrosis with vascularized bone graft: a CT scan experimental study. Skeletal Radiol 1990; 193: 197-202.
22. Adani R, Delcroix L, Innocenti M, et al. Reconstruction of large posttraumatic skeletal defects of the forearm by vascularized free fibular graft. Microsurgery 2004; 246: 423-429.
23. Yoshimura M, Shimamura K, Iwai Y, Yamauchi. Veno T. Free vascularized fibular transplant. A new method for monitoring circulation of the grafted fibula. J Bone Joint Surg (Am) 1983; 65: 1295-1301.
24. Davey PA, Simonis RB. Modification of the Nicoll bone-grafting technique for non-union of the radius and/or ulna. J Bone Joint Surg (Br) 2002; 84: 30-33.
25. Pertea M, Grosu OM., Timofte D, et al. The efficiency of hirudotherapy in venous congestion treatment after replantation. Rev Chim 2020; 713: 350-357.
Published
2020-12-23