Are Vascularized Periosteal Flaps Useful for the Treatment of Difficult Scaphoid Nonunion in Adults? A Prospective Cohort Study of 32 Patients

Campillo-Recio, David; Alabau-Rodriguez, Sergi; Mir-Bulló, Xavier; Soldado, Francisco

doi:10.1016/j.jhsa.2020.06.013

Cited by 7 publications

(7 citation statements)

References 39 publications

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“…No patient suffered pain after a follow-up of at least 2 years. Consistent results can also be observed in a prospective cohort study of 32 patients [ 23 ]: 6 months after surgery, complete bone healing with vascularized periosteal flaps was observed in all patients except 1. An overall gain of 20 in ROM was observed compared to pre-surgery control and 3 months of follow-up; there were no significant differences between treated and untreated (healthy) wrists.…”

Section: Resultssupporting

confidence: 85%

Comparison between Vascular and Non-Vascular Bone Grafting in Scaphoid Nonunion: A Systematic Review

Testa

Lucenti

D’Amato

et al. 2022

JCM

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Background: Scaphoid fractures correspond to 60% of all carpal fractures, with a risk of 10% to progress towards non-union. Furthermore, ~3% present avascular necrosis (AVN) of the proximal pole, which is one of the main complications related to the peculiar vascularization of the bone. Scaphoid non-union can be treated with vascularized and non-vascularized bone grafting. The aim of the study is to evaluate the rates of consolidation of scaphoid non-union treated using two types of grafts. Methods: A systematic review of two electronic medical databases was carried out by two independent authors, using the following inclusion criteria: non-union of the proximal pole of the scaphoid bone, treated with vascular bone grafting (VBG) or non-vascular bone grafting (NVBG), with or without the use of internal fixation, patients aged ≥ 10 years old, and a minimum of 12 months follow-up. Research of any level of evidence that reports clinical results and regarding non-union scaphoid, either using vascularized or non-vascularized bone grafting, has been included. Results: A total of 271 articles were identified. At the end of the first screening, 104 eligible articles were selected for the whole reading of the text. Finally, after reading the text and the control of the reference list, we selected 26 articles following the criteria described above. Conclusions: The choice of the VBG depends mainly on the defect of the scaphoid and on the surgeon’s knowledge of the different techniques. Free vascular graft with medial femoral condyle (MFC) seems to be a promising alternative to local vascularized bone grafts in difficult cases.

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Section: Resultssupporting

confidence: 85%

Comparison between Vascular and Non-Vascular Bone Grafting in Scaphoid Nonunion: A Systematic Review

Testa

Lucenti

D’Amato

et al. 2022

JCM

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“…The PMFC flap should be considered as an alternative in cases of Soldado et al, 2020). The same group also reported a favorable outcome in adult scaphoid nonunion management with a similar technique (Barrera-Ochoa et al, 2020). We chose to use the PMFC for various reasons: its size is large enough to easily wrap around a metacarpal and bridge a potential bone gap; the donor site morbidity is low (Mehio et al, 2018); harvesting the flap poses no technical difficulty and the vessel size is rather large; no major artery needs to be sacrificed.…”

Section: Discussionmentioning

confidence: 93%

Periosteal medial femoral condyle free flap for metacarpal nonunion

et al. 2021

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Background: Metacarpal nonunion is a rare condition. The osteogenic capacity of periosteal free flap was investigated in five patients with metacarpal nonunion and impaired bone vascularization.Patients and methods: Surgery was performed between 64 and 499 days after the initial bone osteosynthesis. The average age was 27.6 (range 16-32) years. Nonunion was caused by excessive periosteal removal in two patients, extensive open trauma in three. Four nonunions were diaphyseal, one metaphyseal. A periosteal medial femoral condyle free flap was raised on the descending genicular artery for four patients, the superomedial genicular artery for one. After osteosynthesis with a plate, the flap was wrapped around the metacarpal, overlapping the bone proximally and distally.The recipient vessel were the dorsal branch of the radial artery and a vena comitans in the anatomical snuffbox in four patients, at the base of the first webspace in one. Results:The flap size ranged from 5 Â 3.5 cm to 8 Â 4 cm. No postoperative complication occurred. Radiological bone union was achieved 3 to 8 months after surgery.One patient had a full range of motion, one a slight extension lag of the proximal interphalangeal joint, two moderate joint stiffness of the proximal interphalangeal or metacarpophalangeal joint (one requiring plate removal and extensor tenolysis), one severe stiffness that allowed using a hook grip which was the aim of the surgery. Conclusion:In case of metacarpal nonunion with impaired bone vascularization, the periosteal medial femoral condyle free flap provides an effective and biomimetic approach to bone healing.

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“…The main benefit of including periosteal extension is its enhancement of bony union, via its rich vasculature and osteogenic properties (Barrera‐Ochoa et al, 2022; Barrera‐Ochoa, Martin‐Dominguez, et al, 2020; Fuchs et al, 2005; Trignano et al, 2013). Prior studies have demonstrated enhanced bony union with implementation of periosteal extension in both children and adults following traumatic injury and oncologic resections, though a majority of the available literature focuses on the pediatric population (Barrera‐Ochoa, Alabau‐Rodriguez, et al, 2020; Soldado et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…While periosteal flaps may be harvested with or without underlying bone, the authors include VFFF given the large bony clavicular gap. Nonetheless, excellent bony union has been described in recalcitrant nonunion of upper extremity fractures managed with periosteal only flaps, such as the vascularized ulnar periosteal pedicled flap and vascularized thumb metacarpal periosteal pedicled flap (Barrera‐Ochoa et al, 2022; Barrera‐Ochoa, Martin‐Dominguez, et al, 2020). In addition to periosteal flaps, the authors incorporated stairstep osteotomies between interlocking clavicle and free flap, to maximize bony interface for healing (Lenoir et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies demonstrate excellent outcomes following clavicular reconstruction with VFFF, including improved shoulder functioning and postoperative pain scores (Abarca et al, 2013; Erdmann et al, 2004; Lenoir et al, 2013; Momberger et al, 2000; Ye & Taylor, 2017). Periosteal extension provides the reconstruction with a vascular bed, promoting bony union and providing additional hardware coverage (Barrera‐Ochoa et al, 2022; Barrera‐Ochoa, Martin‐Dominguez, et al, 2020; Fuchs et al, 2005; Soldado et al, 2012; Soldado et al, 2017). Studies report improvements in bony union in both children and adults following reconstruction with periosteal flaps, however, no report exists describing its use for clavicular defects (Jones et al, 2012; Soldado et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

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Clavicular reconstruction utilizing free fibula flap with periosteal extension

et al. 2022

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Clavicular reconstruction is typically managed conservatively. Despite demonstrating improving outcomes, including range of motion and pain, there are currently no published reports of acute reconstruction with vascularized free fibula flaps (VFFF) or vascularized periosteal extensions in adult patients with clavicular defects. VFFFs have been utilized to correct critical bony defects of the clavicle and chronic nonunions; however, descriptions following acute trauma are rare. Bony union enhancement with periosteal extension has been described in both pediatric and adult populations, but never in the case of clavicular reconstruction. Herein, we seek to fill this gap in the literature by describing the acute reconstruction of a 6.5 cm bony gap in a 29‐year‐old male following a gunshot wound to the chest, utilizing a 6.5 cm VFFF with periosteal extension, and inset to the internal mammary vessels. The postoperative course was uncomplicated, with bony consolidation noted by 10 weeks, and full, pain‐free range of motion at 8 months, showing this technique may be a viable option following acute trauma.

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Are Vascularized Periosteal Flaps Useful for the Treatment of Difficult Scaphoid Nonunion in Adults? A Prospective Cohort Study of 32 Patients

Cited by 7 publications

References 39 publications

Comparison between Vascular and Non-Vascular Bone Grafting in Scaphoid Nonunion: A Systematic Review

Comparison between Vascular and Non-Vascular Bone Grafting in Scaphoid Nonunion: A Systematic Review

Periosteal medial femoral condyle free flap for metacarpal nonunion

Clavicular reconstruction utilizing free fibula flap with periosteal extension

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