Free vascularized iliac bone flap based on deep circumflex iliac vessels graft for the treatment of osteonecrosis of femoral head

Abstract

BackgroundTo investigate the feasibility and clinical efficacy of free vascularized iliac bone flap based on deep iliac circumflex vessels graft for the treatment of osteonecrosis of femoral head (ONFH) in young adults.MethodsEighteen patients (19 hips) undergoing ONFH were included from January 2016 to May 2017. After the debridement of the necrotic bones, the contralateral vascularized iliac bone flap was designed and harvested before grafting, in which the deep circumflex iliac vessels and the transverse branch (or ascending branch) of the lateral circumflex femoral artery and their accompanying veins were anastomosed. X-ray was obtained at 1, 3, 6, 9, and 12 months respectively for evaluation of the bone flap healing. Hip function was evaluated with Harris hip score at 18 months postoperatively.ResultsNone of the patients is lost to follow-up. All the hips healed well except for four complications: one patient developed superficial wound infection, one patient had subcutaneous hematoma, and two patients developed anterolateral femoral cutaneous nerve injury. X-ray films at 12 months showed improvement in 13 hips (68.4%), five hips (26.3%) were unchanged, and one femoral head collapse with conversion to total hip arthroplasty (THA) at 14 months postoperatively (5.3%). Postoperative mean Harris hip scores were significantly improved compared to the preoperative results (P < 0.05).ConclusionFree vascularized iliac bone flap based on deep circumflex iliac vessels graft is an acceptable treatment option for young adult ONFH in mid-late stage with low conversion to THA rate at short-term follow-up.

CD41-deficient exosomes from non-traumatic femoral head necrosis tissues impair osteogenic differentiation and migration of mesenchymal stem cells

“…Non-traumatic osteonecrosis of the femoral head (ONFH) is a common disease characterized by rapid procession, high disability rate and severe influence on life quality 1,2 . In the US, 10,000-20,000 patients are newly found to be affected with the disease per year 3 and in China, 100,000-200,000 new cases were reported per year 4 .…”

Comparison of free vascularized iliac bone flap grafting versus pedicled iliac bone flap grafting for treatment of osteonecrosis of the femoral head

“…16 , 17 FVIBFs were harvested from the ilium on the opposite site ( Figure 2 , Supplement materials figure 1B, C); the procedure has been introduced in detail in another recently published article by the authors. 15 The iliac bone flap was based on the deep circumflex iliac artery (DCIA) and concomitant vein. When the pedicle and flap were harvested, the lateral femoral cutaneous nerve (LFCN) was carefully preserved by elaborative disassociation between nerve and surrounding tissues.…”

“…Owing to the development of microsurgical techniques, free vascularized iliac bone flap (FVIBF) grafting for the treatment of ONFH has also become feasible. 15 Regardless of the complexity in flap transfer and the risk of vascular compression, the FVIBF may be more advantageous than PIBF. Notwithstanding, this hypothesis has not been thoroughly studied or validated.…”

β‐ecdysone promotes osteogenic differentiation of bone marrow mesenchymal stem cells

“…In the model group, the rats were intravenously injected with lipopolysaccharide (10 μg/kg; Sigma); after 24 hours, the rats received an intramuscular injection of methylprednisolone (20 mg/kg; Meilunbio, Dalian, China) three times a day for 5 consecutive days to establish the ONFH model. 12 For comparison, rats in the control group were given the same amount of saline. Finally, all rats were sacrificed by an overdose of anesthesia, and the femoral heads and distal femurs were collected.…”