Spinal Reconstruction with Free Vascularised Bone Grafts; Approaches and Selection of Acceptor Vessels

Abstract

The use of free vascularised bone grafts is an infrequently performed surgical technique for the reconstruction of spinal defects. This field of surgery brings many challenges concerning the choice of free vascularised bone graft, planning of the operative procedure and selection of recipient vessels. This study aims to report our experience with free vascularised bone grafts, with special emphasis on the surgical approach and the selection of recipient vessels. Over a period of 17 years (1994-2011), we used these grafts for anterior spinal reconstruction in 30 patients. In 28 patients, a free vascularised fibular graft was used, and in two cases a free vascularised iliac crest graft was used. The spinal segments reconstructed involved the cervical or cervicothoracic spine (6 cases), the thoracic spine (11 cases) and the thoracolumbar and lumbosacral spine (13 cases). Revascularisation of the free vascularised bone graft proved to be technically feasible in 30 patients, but failed in one fibular graft due to difficulties with recipient vessels in the lumbar region. Technical challenges were met with respect to the choice of the recipient vessel at various anatomical sites. Availability of acceptor vessels was highly de-pendant of the type of surgery (resection or stabilisation) and the selected surgical approach. Based on these findings, a preferred approach is given for each region. The use of free vascularised bone grafts is a valuable technique for the reconstruction of complex spinal disorders. Successful execution requires microvascular expertise with respect to graft harvesting and appropriate choice of recipient vessels. Adequate preoperative planning in a multidisciplinary setting and adherence to the basic principles for spinal reconstruction are required.

Colgajo libre de peroné para reconstrucción cervical y de pared faríngea tras resección de cordoma

“…Incluso ha sido útil en la reconstrucción tras osteomielitis. (18) Winters y col. (12) describieron el uso del colgajo de peroné en 21 pacientes con reconstrucción de defectos vertebrales. Krishnan y col. (9) reportaron el uso del colgajo de peroné en un caso de fusión vertebral a múltiples niveles.…”

“…(9) Los tejidos óseos vascularizados, en contraste, mantienen su viabilidad como resultado de la restauración del flujo sanguíneo periostico y endóstico. (10)(11)(12) Este proceso determina una cicatrización más acelerada y estable.…”

Osseous Reconstruction of Complex Defects of the Lumbar Spine

“… 1 The growing trend for reconstruction of defects of the axial skeleton is toward vascularized bone grafting (VBG). 2 , 3 For large, complex defects, a combination of anterior and posterior approaches are required to prevent damage to the great vessels. 4 The literature is unclear whether it is optimal to utilize VBG for the anterior or posterior column reconstruction or both.…”

“…Pedicled rib grafts and free fibular flaps have become the mainstays of treatment in spinal reconstruction. 3 Soft-tissue reconstruction in the lumbar region is difficult due to the dense fascial connections to the underlying thoracolumbar fascia and a lack of axial blood vessels. Transposition of the paraspinous musculature as a bipedicled flap may be an option for small defects.…”

Donor Site Morbidity as a Problem of Spinal Surgery: Systematic Review

“…При операциях на позвоночнике несвободная костная пластика практически ограничена использованием кровоснабжаемого реберного трансплантата [22,38,59]. При резекциях единым блоком по поводу злокачественных новообразований [4,57] и повторных костных пластиках при остеомиелите позвонков [6,46] возможно применение свободного кровоснабжаемого трансплантата из малоберцовой кости или гребня подвздошной кости [60]. Так как реваскуляризация трансплантата значительно повышает травматичность операции за счет продолжительного микрохирургического этапа, показания к этой методике существенно ограничены.…”