Vascularized humeral periosteal flap to treat lateral humeral condyle nonunion: An anatomical study and report of two successfully‐treated pediatric cases

Soldado, Francisco; Rodríguez‐Baeza, Alfonso; Diaz‐Gallardo, Paula; Hodgson, Felipe; Corona, Pablo S.; Knörr, Jorge

doi:10.1002/micr.30261

Cited by 15 publications

(15 citation statements)

References 17 publications

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“…As such, in recent years, we started the study and clinical application of pediculated VPFs in upper extremity defects to obtain a surgical technique complying with the premises of technical ease, graft adaptability, osteoinductive capacity and fast integration, as well as low donor area morbidity. [16][17][18][19] Consolidation and revascularization of the bone defect were obtained in all cases, with no complications. 17 This paper summarizes and details the fundamental aspects of the surgical technique, the regional anatomy studied through cadaveric dissections, and the indications for pediculated VPFs in upper limb conditions.…”

Section: Introductionmentioning

confidence: 87%

“…Distally, VRCPs join the interosseous recurrent artery and the radial recurrent artery to create a vascular network over the lateral condyle. 18…”

Section: Periosteal Humeral Vascularized Flap Anatomymentioning

confidence: 99%

“…The reported average incidence of pseudoarthrosis after distal humerus fractures ranges from 2% to 10%. 7,18,20 In children, humeral lateral condyle (CLH) fractures are the second most common elbow fracture, and nonunion is a relatively common complication, 15 resulting in a high risk of bone necrosis and chronic elbow stiffness. 15,20 Open reduction and internal fixation with or without autologous or heterologous bone graft remains the most frequent treatment method.…”

Section: Clinical Usefulnessmentioning

confidence: 99%

“…Follow-up radiographs showed peri-implant loosening. 18 A lateral longitudinal incision was made and the lateral humeral septum and VRCP were identified. The brachioradialis/brachialis muscle fibers were separated anteriorly, whereas triceps muscle fibers were separated posteriorly.…”

Section: Palabras Clavementioning

confidence: 99%

“…It has an optimal size for small defects of up to 4 cm 2 . The length of its pedicle (5.2 cm) allows it to be used both for scaphoid pseudoarthrosis and/or avascular necrosis either by a volar and dorsal approach [17][18][19][20][21][22][23][24][25] . It can also be used for semilunar necrosis or Kienböck disease through a dorsal approach, although 4-5 radial VPFs are often preferred in such cases.…”

Section: Clinical Usefulnessmentioning

confidence: 99%

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Use of Vascularized Periosteal Flaps in Upper Extremity Pathology

Alabau-Rodriguez

Liburd

González

et al. 2020

Revista Iberoamericana de Cirugía de la Mano

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Massive bone defects represent a challenge in orthopedics. The structural and biological contribution of vascularized bone flaps has significantly improved their treatment. Similarly, free vascularized periosteal flaps (VPF) have been used to treat bone defects in children, with higher flexibility, adaptability to the recipient's bed and good osteogenic and osteoinductive capacity. However, these are complex techniques related to donor area morbidity. We have started anatomical and clinical studies on the application of pediculated VPF in recalcitrant massive defects to reduce this morbidity. This article summarizes the fundamental aspects of the surgical technique, the main anatomical findings from cadaveric dissections and the applicability of pediculated VPF to treat biologically unfavorable bone defects at the upper limb. The authors review the vascularized humeral periosteal flap (VHPF), the dorso-ulnar and volar-radial forearm periosteal flaps and the vascularized first metacarpal periosteal flap, all described in previous papers. As a novelty, the dorsal wrist and hand VPF (4-5 radial periosteal flap and dorsum of the second metacarpal bone periosteal flap) are presented. In addition, clinical cases with recent VPF applications in common upper limb conditions are described.

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Section: Introductionmentioning

confidence: 87%

“…Distally, VRCPs join the interosseous recurrent artery and the radial recurrent artery to create a vascular network over the lateral condyle. 18…”

Section: Periosteal Humeral Vascularized Flap Anatomymentioning

confidence: 99%

Section: Clinical Usefulnessmentioning

confidence: 99%

Section: Palabras Clavementioning

confidence: 99%

Section: Clinical Usefulnessmentioning

confidence: 99%

See 3 more Smart Citations

Use of Vascularized Periosteal Flaps in Upper Extremity Pathology

Alabau-Rodriguez

Liburd

González

et al. 2020

Revista Iberoamericana de Cirugía de la Mano

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Effect of vascularized periosteum on revitalization of massive bone isografts: An experimental study in a rabbit model

et al. 2020

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Introduction In the last years, limb salvage has become the gold standard treatment over amputation. Today, 90% of extremity osteogenic sarcomas can be treated with limb salvage surgery. However, these reconstructions are not exempt from complications. Massive allografts have been associated to high risk of nonunion (12–57%), fracture (7–30%) and infection (5–21%). Association of vascularized periosteum flap to a massive bone allograft (MBA) has shown to halve the average time of allograft union in clinical series, even compared to vascularized fibular flap. Creeping substitution process has been reported in massive allograft when periosteum flap was associated. However, we have little data about whether it results into allograft revitalization. We hypothesize that the association of a periosteum flap to a bone isograft promotes isograft revitalization, defined as the colonization of the devitalized bone by new‐form vessels and viable osteocytes, turning it vital. Materials and Methods Forty‐four New Zealand white male rabbits underwent a 10 mm segmental radial bone defect. In 24 rabbits the bone excision included the periosteum (controls); in 20 rabbits (periosteum group) bone excision was performed carefully detaching periosteum in order to preserve it. Cryopreserved bone isograft from another rabbit was trimmed and placed to the defect gap and was fixed with a retrograde intramedullar 0.6 mm Kirschner wire. Rabbits were randomized and distributed in 3 subgroups depending on the follow‐up (control group: 5 rabbits in 5‐week follow up group, 8 rabbits in 10‐week follow‐up group, 7 rabbits in 20‐week follow‐up group; periosteum group: 5 rabbits in 5‐week follow up group, 7 rabbits in 10‐week follow‐up group, 7 rabbits in 20‐week follow‐up group). Fluoroscopic images of rabbit forelimb were taken after sacrifice to address union. Each specimen was blindly evaluated in optical microscope (magnification, ×4) after hematoxylin and eosin staining to qualitative record: presence of new vessels and osteocytes in bone graft lacunae (yes/no) to address revitalization, presence of callus (yes/no) and woven bone and cartilage tissue area (mm2) to address remodeling (osteoclast resorption of old bone and substitution by osteoblastic new bone formation). Results No isograft revitalization occurred in any group, but it was observed bone graft resorption and substitution by new‐formed bone in periosteum group. This phenomenon was accelerated in 5‐week periosteum group (control group: 49.5 ± 9.6 mm2 vs. periosteum group: 34.9 ± 10.4 mm2; p = .07). Remodeled lamellar bone was observed in both 20‐week groups (control group: 6.1 ± 6.3 mm2 vs. periosteum group: 5.8 ± 3.0 mm2, p = .67). Periosteum group showed complete integration and graft substitution, whereas devitalized osteons were still observed in 20‐week controls. All periosteum group samples showed radiographic union through a bone callus, whereas controls showed nonunion in eight specimens (Union rate: control group 60% vs. periosteum group 100%, p = .003). Conclus...

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Bone nonunion management in children with a vascularized tibial periosteal graft

et al. 2020

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Background: Vascularized periosteal graft have demonstrated a tremendous bone healing capacity in children. The objective is to report outcomes on the use of vascularized tibial periosteal graft (VTPG) during bone reconstruction in a series of children with complex bone healing problems. Patients and methods: Cases were collected retrospectively since May 2013 to May 2019, excluding cases of congenital pseudarthrosis of the tibia. Mean age at surgery was 12.8 (range 11-18) years. Indications included treatment of recalcitrant bone nonunion and the prevention of bone allograft-host junction nonunion in seven and three patients, respectively. The periosteal flap, based on the anterior tibial vessels, was harvested as a free flap in six instances and as a pedicled flap in four. Results: Mean follow-up was 25.2 months (range 8-36). The flap showed a 13.6 cm (range 9-16) and mean width 3.4 cm (range 2.7-3.9). Early bone union was achieved, initially through periosteal callus, followed by cortical union at mean times of 2 and 4 months, respectively, in nine cases. The flap was not successful in a patient with severe comorbidities. No donor site complications were registered. Conclusions: VTPG was fast and high effective for the treatment complex bone nonunion or the prevention of allograft nonunion in children.

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Vascularized humeral periosteal flap to treat lateral humeral condyle nonunion: An anatomical study and report of two successfully‐treated pediatric cases

Abstract: VHPF might be considered a viable biological surgical option to promote bone healing in LCH nonunions in children, while avoiding the need for bone fixation and the donor morbidity associated with bone grafting.

Cited by 15 publications

References 17 publications

Use of Vascularized Periosteal Flaps in Upper Extremity Pathology

Use of Vascularized Periosteal Flaps in Upper Extremity Pathology

Effect of vascularized periosteum on revitalization of massive bone isografts: An experimental study in a rabbit model

Bone nonunion management in children with a vascularized tibial periosteal graft

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