Postoperative monitoring of free vascularized bone grafts in reconstruction of bone defects

Pliefke, Jenny; Rademacher, G.; Zach, A.; Bauwens, Kai; Eisenschenk, A.

doi:10.1002/micr.20662

Cited by 14 publications

(9 citation statements)

References 74 publications

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“…56 There is no optimal method in evaluating viability of the vascularized fibular graft, especially in the early postoperative period. 57 The skin island flap is usually reliable allowing continues clinical evaluation but not always adequate for evaluating overall flap viability. 57 In cases of arterial thrombosis, re-exploration of the anastomosis is indicated.…”

Section: Complicationsmentioning

confidence: 99%

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Vascularized fibula transfer for lower limb reconstruction

et al. 2011

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Massive bony defects of the lower extremity are usually the result of high-energy trauma, tumor resection, or severe sepsis. Vascularized fibular grafts are useful in the reconstruction of large skeletal defects, especially in cases of scarred and avascular recipient sites, or in patients with combined bone and soft-tissue defects. Microvascular free fibula transfer is considered the most suitable autograft for reconstruction of the middle tibia because of its long cylindrical straight shape, mechanical strength, predictable vascular pedicle, and hypertrophy potential. The ability to fold the free fibula into two segments or to combine it with massive allografts is a useful technique for reconstruction of massive bone defects of the femur or proximal tibia. It can also be transferred with skin, fascia, or muscle as a composite flap. Proximal epiphyseal fibula transfer has the potential for longitudinal growth and can be used in the hip joint remodeling procedures. Complications can be minimized by careful preoperative planning of the procedure, meticulous intraoperative microsurgical techniques, and strict postoperative rehabilitation protocols. This literature review highlights the different surgical techniques, indications, results, factors influencing the outcome, and major complications of free vascularized fibular graft for management of skeletal or composite defects of the lower limb.

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Section: Complicationsmentioning

confidence: 99%

“…57 The skin island flap is usually reliable allowing continues clinical evaluation but not always adequate for evaluating overall flap viability. 57 In cases of arterial thrombosis, re-exploration of the anastomosis is indicated. However, the treatment of venous congestion of the skin flap is under debate.…”

Section: Complicationsmentioning

confidence: 99%

Vascularized fibula transfer for lower limb reconstruction

et al. 2011

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“…Sufficient bone blood flow must be maintained for the successful repair of large skeletal defects using bone grafts (119)(120). Since the late 1970s, vascularized fibular bone (VFB) grafts have been used to treat osteonecrosis of the femoral head (121).…”

Section: Blood Flow In Bone Graftsmentioning

confidence: 99%

Skeletal Blood Flow in Bone Repair and Maintenance

2013

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Bone is a highly vascularized tissue, although this aspect of bone is often overlooked. In this article, the importance of blood flow in bone repair and regeneration will be reviewed. First, the skeletal vascular anatomy, with an emphasis on long bones, the distinct mechanisms for vascularizing bone tissue, and methods for remodeling existing vasculature are discussed. Next, techniques for quantifying bone blood flow are briefly summarized. Finally, the body of experimental work that demonstrates the role of bone blood flow in fracture healing, distraction osteogenesis, osteoporosis, disuse osteopenia, and bone grafting is examined. These results illustrate that adequate bone blood flow is an important clinical consideration, particularly during bone regeneration and in at-risk patient groups. IntroductionThe rate at which blood vessels deliver oxygen, nutrients, growth factors, and circulating cells to boneis tightly regulated as a function of blood pressure and vascularizaAll biological tissues, including bone, require vascular support to survive. However, a frequently overlooked feature of bone is its extensive vascular network. Many studies have demonstrated that the blood vessels in bone are necessary for nearly all skeletal functions, including development, homeostasis, and repair (1). In addition, blood vessels lost due to trauma are regenerated, and new bone tissue formed in response to injury is vascularized. As a consequence of this environment, the blood vessels in bone are highly active, not simply a passive source for the delivery of nutrients (2). Readers are referred to recent publications for more information about the active processes of the vasculature not covered in this review, including the vascular niche and hypoxia-driven signaling pathways (3-4). tion. Given that blood pressure is generally maintained, the number and size of blood vessels determines the local blood flow rate. These two factors are regulated through the processes of angiogenesis and vasomotor function, respectively. Although a variety of skeletal disorders are associated with general vascular dysfunction (5-7), this review will focus on the regulation of bone blood flow, through the number and size of vessels, during bone repair and regeneration. To introduce this topic, the skeletal vascular anatomy and techniques for measuring bone blood flow are briefly discussed. Blood supply in boneA dense vascular network delivers oxygen and nutrients to all 206 bones in the human body. In general, this requires a substantial portion of the total cardiac output. Experimental work in various animal species has demonstrated that a significant portion of the resting cardiac output is directed to the skeleton, likely between 10% and 15% (8-12).For some time, the blood flow pattern in bones has been described as primarily centrifugal: blood is supplied to the cortical bone through the nutrient arteries in the (Figure 1), and returned by the periosteal veins (13). Particularly in long bones, the vascular anatomy is well characterized, wi...

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“…Eisenschenk et al [14,15] sowie Pliefke et al [25] berichteten über eine gute und aussagekräftige Kontrolle der Durchblutung (Überprüfung der Anastomosendurchgängigkeit) auch bei liegendem Osteosynthesematerial 3 Monate postoperativ, sodass die Autoren die Angiographie als Monitoringmethode im Rahmen der postoperativen Rehabilitation favorisieren würden (. Abb.…”

Section: Angiographieunclassified