Combined massive allograft and intramedullary vascularized fibula transfer: the Capanna technique for treatment of congenital pseudarthrosis of the tibia

Abstract

Background and purpose — Congenital pseudarthrosis of the tibia (CPT) is caused by local periosteal disease that can lead to bowing, fracturing, and pseudarthrosis. Current most successful treatment methods are segmental bone transport and vascularized and non-vascularized bone grafting. These methods are commonly hampered by discomfort, reoperations, and long-term complications. We report a combination of a vascularized fibula graft and large bone segment allograft, to improve patient comfort with similar outcomes. Patients and methods — 7 limbs that were operated on in 6 patients between November 2007 and July 2018 with resection of the CPT and reconstruction with a vascularized fibula graft in combination with a bone allograft were retrospectively studied. The mean follow-up time was 5.4 years (0.9–9.6). Postoperative endpoints: time to discharge, time to unrestricted weight bearing, complications within 30 days, consolidation, number of fractures, and secondary deformities. Results — The average time to unrestricted weight bearing with removable orthosis was 3.5 months (1.2–7.8). All proximal anastomoses consolidated within 10 months (2–10). 4 of the 7 grafts fractured at the distal anastomosis between 6 and 14 months postoperatively. After reoperation, consolidation of the distal anastomosis was seen after 2.8 months (2–4). 1 patient required a below-knee amputation. Interpretation — This case series showed favorable results of the treatment of CPT through a combination of a vascularized fibula graft and large bone segment allograft, avoiding the higher reintervention rate and discomfort with ring frame bone transport, and the prolonged non-weight bearing with vascularized fibula transfer without reinforcement with a massive large bone segment allograft.

Strategies for large bone defect reconstruction after trauma, infections or tumour excision: a comprehensive review of the literature

“…First described by Capanna et al in the early 1990s [ 47 ], this technique consists of combining the advantages provided by the mechanical strength of allografts and the advantages of the biological properties of the autograft [ 31 , 48 ]. The allograft mainly provides bone support and early stability, while the vascularized fibula facilitates the integration between host and allograft, and has the ability to rapidly consolidate [ 31 , 49 , 50 ]. This hybrid graft can be assembled by the intramedullary or the onlay technique [ 50 , 51 ].…”

“…The allograft mainly provides bone support and early stability, while the vascularized fibula facilitates the integration between host and allograft, and has the ability to rapidly consolidate [ 31 , 49 , 50 ]. This hybrid graft can be assembled by the intramedullary or the onlay technique [ 50 , 51 ]. The intramedullary technique consists of inserting the vascularized fibula inside the allograft (Fig.…”

Multidisciplinary team meetings for patients with complex extremity defects: a retrospective analysis of treatment recommendations and prognostic factors for non-implementation

“…Author details 1 Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center-BG Trauma Center Ludwigshafen, Hand and Plastic Surgery of the University of Heidelberg, Ludwig Guttmann Str. 13, 67071 Ludwigshafen, Germany.…”

“…Depending on the defect size and localization, involvement of tissue components, and presence of infection, the reconstructive approach can range from simple to complex procedures. Large osseous defects may necessitate cryopreserved allogeneic or microvascular autologous bone transplants, bone prostheses, or bone transport via Masquelet technique [1][2][3]. Concomitant or extensive soft tissue defects may require microvascular free flap coverage and severe damage to muscle groups may indicate complex tendon transfer or muscle neurotization [4][5][6].…”

Multidisciplinary Team Meetings for Patients with Complex Extremity Defects – A Retrospective Analysis of Treatment Recommendations and Prognostic Factors for Non-Implementation.

“…Depending on the defect size and localization, involvement of tissue components, and presence of infection, the reconstructive approach can range from simple to complex procedures. Large osseous defects may necessitate cryopreserved allogeneic or microvascular autologous bone transplants, bone prostheses, or bone transport via Masquelet technique [1][2][3]. Concomitant or extensive soft tissue defects may require microvascular free ap coverage and severe damage to muscle groups may indicate complex tendon transfer or muscle neurotization [4,5] [6] In addition, depending on the underlying disease, optimization of the vascular status might be necessary.…”