Using Vascularized Fibula Graft in Treatment Children With Bone Defects – The Possibility of Further Reconstructive Surgery

Garkavenko, Yuriy E.; Zakharyan, Ekaterina A.; Зубаиров, Тимур Фаизович; Pozdeev, A.P.; Dolgiev, B.K.; Sosnenko, O.N.; Pozdeev, Andrey A.; Белоусова, Е. А.; Chigvariya, Nikolai Georgievich

doi:10.17513/spno.30624

СПНО (MPSE)

2021

DOI: 10.17513/spno.30624

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Using Vascularized Fibula Graft in Treatment Children With Bone Defects – The Possibility of Further Reconstructive Surgery

Yuriy E. Garkavenko¹,

Ekaterina A. Zakharyan²,

Тимур Фаизович Зубаиров³

et al.

Abstract: Представлен клинический случай пациента детского возраста, которому было выполнено многоэтапное хирургическое лечение, направленное на устранение дефекта бедренной кости, заключающееся в замещении дефекта левой бедренной кости путем аутотрансплантации фрагмента малоберцовой кости при помощи микрохирургической техники и проведения двух этапов удлинения конечности методом дистракционного остеосинтеза. Пациент впервые поступил в клинику института в возрасте 7 лет, после ранее перенесенного острого гематогенного о… Show more

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Microsurgical autologous ffbula transfer as an optimal method for closure of extensive bone defects in children with neuroffbromatosis

Golyana,

Tikhonenko,

Galkina

et al. 2023

jour

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Introduction Pseudarthrosis and bone defects are the most common consequence of neurofibromatosis type I in children, a rare hereditary disease. Destruction of bone tissue leads to severe deformities and impaired function of the limbs. Disability in such patients may reach 70 %. Surgical treatment of children with this pathology is long, laborious and multi-stage. Traditional orthopaedic methods for managing bone defects are often ineffective. The development of microsurgical methods enables to perform bone transfer of blood-supplied bone autografts.Purpose To prove the effectiveness of using microsurgical autologous transfer of the vascularized fibula for plastic surgery of bone defects in children with neurofibromatosis type I.Materials and methods A retrospective monocenter study included 27 pediatric patients who underwent reconstruction of bone defects with a vascularized fibular autograft from 2011 to 2021. The etiology of the bone defect in all patients was neurofibromatosis type I. A fibula graft was used to reconstruct 8 tibiae and 19 forearms. Bone defects averaged 12 cm. Median follow-up was 60 months.Results The fibula graft survival rate was 100 %. In 5 cases, nonunion of the proximal part of the fibula and the recipient zone was obtained which required iliac crest grafting. The overall rate of good and excellent results was 74 %. The average time to consolidation was 3 months. Discussion According to the literature, the use of autografting of vascularized bone fragments is a ather limited procedure in children with neurofibromatosis type I as it is associated with an increased risk of complications. Due to the restoration of blood flow in the transferred vascularized autograft, it retains its viability and the possibility of bone tissue remodeling.Conclusion Microsurgical autologous transfer of a vascularised fragment of the fibula is an effective and at times indispensable method of bone plasty in long bone defects in children with type 1 neurofibromatosis. Bone defects larger than 5 cm are an indication for free autologous transfer of a vascularized fragment of the fibula. This method, used in combination with traditional orthopedic methods for the treatment of children, allows obtaining good anatomical and functional results.

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Microsurgical autologous ffbula transfer as an optimal method for closure of extensive bone defects in children with neuroffbromatosis

Golyana,

Tikhonenko,

Galkina

et al. 2023

jour

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Promising osteoplastic materials and surgical technologies in reconstructive treatment of patients with bone nonunion and defects

Borzunov,

Gilmanov

2024

jour

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Introduction Some progress has been made in the development of innovative implantation materials for osteoplastic surgery. However, the problem of bone defect management still remains relevant due to the continued high prevalence of injuries resulting from road accidents, catatrauma, man-made disasters and military operations.The purpose of the work was to analyze the relevant literature and to identify options for solving the problems of bone nonunion and defect management using materials developed on the principles of orthobiology and surgical technologies based on autologous repair.Materials and methods The search for sources was carried out with the ConnectedPapers analytical tool and the capabilities of the eLibrary electronic library using keywords and without restrictions on publication date.Results and discussion Recent publications contain information about the effectiveness of the combination of Masquelet technology and Ilizarov bone transport in patients with acquired and congenital defects, including in the conditions of active purulent infection. According to the literature, a promising autologous bone plastic material is the contents of the bone marrow cavity, containing osteogenic growth factors and bone morphogenetic proteins. Biomaterial is collected using the Reamer-Irrigator-Aspirator system (RIA) from the intramedullary canal of the femur or tibia. Currently, the effectiveness of bone morphogenetic proteins rhBMP-2 and rhBMP-7 in the restorative treatment of patients with bone defects and nonunion of various etiologies has actually been proven. The use of bone morphogenetic proteins has been introduced into foreign treatment protocols. Recent positive results of a combination of surgical technologies have proposed the combined use of the Ilizarov and Masquelet technologies, supplemented by PRP therapy. The basis for the expected effect from the combination of surgical technologies and orthobiological materials are the results of preclinical studies of the osteogenic potential of PRP therapy.Conclusion There are grounds for studying the clinical effect of the combined use of surgical technologies based on autologous reparative processes and materials developed on the principles of orthobiology. It is necessary and advisable to clinically implement the use of bone morphogenetic proteins rhBMP-2 and rhBMP-7 in the reconstructive treatment of patients with bone defects and nonunion of various etiologies. Multicenter clinical studies of a high level of evidence are needed to determine the effectiveness of PRP therapy in the reconstructive treatment of patients with bone nonunion and defects.

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Using Vascularized Fibula Graft in Treatment Children With Bone Defects – The Possibility of Further Reconstructive Surgery

Cited by 2 publications

References 7 publications

Microsurgical autologous ffbula transfer as an optimal method for closure of extensive bone defects in children with neuroffbromatosis

Microsurgical autologous ffbula transfer as an optimal method for closure of extensive bone defects in children with neuroffbromatosis

Promising osteoplastic materials and surgical technologies in reconstructive treatment of patients with bone nonunion and defects

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