Treatment of Nonunion of Forearm Bones Using Radial Forearm Bone Flap

Kamrani, Reza Shahryar; Farhoud, Amir Reza; Nabian, Mohammad Hossein; Farhadi, Leila

doi:10.5812/traumamon.22622

Cited by 6 publications

(3 citation statements)

References 29 publications

(45 reference statements)

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“…This elasticity explains the elastic retraction in the size of the post-dissection flap when compared with the pre-dissection size. 8,[13][14][15][16] In addition, unlike the microsurgical procedures, the VPF described decreases the morbidity of the donor areas.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Study of Periosteal Vascularization of the Forearm: Design of Vascularized Periosteal Flaps

Campillo-Recio

Knörr

Mir-Bulló

et al. 2018

Rev Iberoam Cir Mano

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Introduction Vascularized periosteal flaps (VPFs) have proven to be a useful technique for the treatment of unfavorable biological situations in children, with excellent results due to their osteogenic potential. The objective of this work is to present a detailed anatomical description of the periosteal vascularization of the radius and ulna, as well as the design of the forearm VPFs. Methods Anatomical study with 10 fresh-frozen specimens with antegrade injection of green colored latex. Periosteal branches of the radius and ulna, septocutaneous branches, and muscular branches were dissected. The size of the pre and postdissection flaps was measured, as well as the length of the vascular pedicles. Results The four vascular axes studied were the anterior interosseous vascular axis (AIA), radial axis (RA), ulnar axis (UA), and posterior interosseous vascular axis (PIA). The AIA (volar-radial VPF): an average of 16.2 periosteal branches were obtained, with a mean distance of 6.6 mm between them. The mean size of the VPF was 41.3 cm2 pre-dissection and 32.4 cm2 post-dissection. The average pedicle length was 16.1 cm. Vascular RA (radial VPF): an average of 20.8 branches was found, with a mean VPF size of 54.8 cm2predissection, and 39.3 cm2 post-dissection. The average pedicle length was 20.2 cm. Vascular PIA (dorsal-ulnar VPF): an average of 12.8 periosteal branches were obtained, with the mean VPF size being 26.2 cm2 pre-dissection and 20.4 cm2 post-dissection. The average pedicle length 12.6 cm. Vascular UA (ulnar VPF): an average of 10.2 periosteal branches were obtained with a mean VPF size of 37.5 cm2 pre-dissection and 28.2 cm2 post-dissection. of the average pedicle length was 14.8 cm. Conclusions We have described four new VPFs, with the most useful and versatile being the dorsal-ulnar VPF, based on the PIA, and the volar-radial, based on the AIA. The main advantages of these flaps with respect to microsurgical techniques are the simplicity and speed of the technique, its elasticity and adaptability to the recipient bed, as well as its versatility.

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Section: Discussionmentioning

confidence: 99%

Anatomical Study of Periosteal Vascularization of the Forearm: Design of Vascularized Periosteal Flaps

Campillo-Recio

Knörr

Mir-Bulló

et al. 2018

Rev Iberoam Cir Mano

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“…No radial donor-site fractures were mentioned in any of these studies although donor-site morbidity was not specifically addressed. [18][19][20][21][22] As the uses of the ORFFF continue to expand in upper extremity reconstruction, the same principles of prophylactic plating may be useful to minimize the risk of donor-site fracture while avoiding the morbidity of an additional, iliac crest donor site.…”

Section: Discussionmentioning

confidence: 99%

Donor-Site Outcomes for the Osteocutaneous Radial Forearm Free Flap

Satteson

Waltonen

et al. 2017

J reconstr Microsurg

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Background This study sought to characterize the donor-site complications associated with the osteocutaneous radial forearm free flap (ORFFF) used for mandibular reconstruction, as well as to compare donor-site complications between the ORFFF and fasciocutaneous radial forearm free flap (FRFFF). Methods An Institution Review Board approved, retrospective review identified all ORFFF and FRFFF performed for head and neck reconstruction with a single otolaryngology surgeon at an academic medical center over a 3-year period. Patients requiring an ORFFF underwent harvest of half of the diaphyseal diameter of the radius with prophylactic plating performed by hand surgeons. Donor-site outcomes including infection, skin graft loss, tendon exposure, neuropathy, radius fracture, hardware complications, and need for additional donor-site surgery were compared. Results In this study, 25 patients underwent ORFFF harvest, and 52 underwent FRFFF harvest. There was one radius fracture occurring in association with a hardware infection requiring reoperation. No fractures or other major donor-site complications were seen in the FRFFF group. Similar rates of minor complications were noted with skin graft take less than 50% in 4% (n = 1) and 8% (n = 4) with ORFFF and FRFFF, respectively, and tendon exposure in 8% (n = 2) and 15% (n = 8) with ORFFF and FRFFF, respectively. No soft tissue infections or sensory neuropathies were seen. Mean follow-up was 14.2 months for the ORFFF group and 11.7 months for the FRFFF group. Conclusion The risk of fracture following ORFFF harvest with prophylactic plating is small. Other donor-site complication rates were similar with both flap techniques.

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“…Due to this function forearm fractures must be treated as articular fractures and not as diaphyseal ones. Treatment of forearm fractures with compression plating presents a union rate of more than 95% [ 1 , 2 ]. Factors affecting the result of forearm fixation apart from the surgical technique are osteoporosis, mechanism of injury, and patient’s compliance [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

A Challenging Case of Extraordinary – Long standing Forearm Non-union Treated with Extensive Debridement, Locking Plates, and Bone Grafting. Technical Considerations in Multiple-operated, Neglected Non-unions

Komnos¹,

Papageorgiou²,

Malizos³

2021

JOCR

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Introduction: Forearm non-unions pose a significant treatment challenge to orthopedic surgeons. Repetitive treatment failures can lead to a devastating situation for the patient. Forearm function influences both elbow and wrist proper function. Case Report: A functionless hand is presented, describing a longstanding non-union, treated with multiple surgeries before. A thorough debridement with respect to blood supply and local biology are of major importance before applying the locking plates along with the use of bone-graft. The reconstruction of the forearm converted a functionless arm to a fully functioning arm and the patient returned eventually to her previous activities. Conclusion: Fixation with locking plates combined with the use of autograft can lead to very satisfactory results even in extraordinary cases, especially when attention is paid to local anatomy and blood supply. Keywords: Forearm nonunion, locking plates, multiple surgeries.

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Treatment of Nonunion of Forearm Bones Using Radial Forearm Bone Flap

Cited by 6 publications

References 29 publications

Anatomical Study of Periosteal Vascularization of the Forearm: Design of Vascularized Periosteal Flaps

Anatomical Study of Periosteal Vascularization of the Forearm: Design of Vascularized Periosteal Flaps

Donor-Site Outcomes for the Osteocutaneous Radial Forearm Free Flap

A Challenging Case of Extraordinary – Long standing Forearm Non-union Treated with Extensive Debridement, Locking Plates, and Bone Grafting. Technical Considerations in Multiple-operated, Neglected Non-unions

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