Vascularized tibial periosteal graft in complex cases of bone nonunion in children

Abstract

Bone nonunion in the pediatric population usually occurs in the context of highly unfavorable biological conditions. Recently, the vascularized fibular periosteal flap has been reported as a very effective procedure for treating this condition. Even though a vascularized tibial periosteal graft (VTPG) was described long ago and has been successfully employed in one adult case, there has been no other report published on the use of this technique. We report on the use of VTPG, pedicled in the anterior tibial vessels, for the treatment of two complex pediatric bone nonunion case: a recalcitrant supracondylar femoral pseudarthrosis secondary to an infection in an 11-year-old girl, and a tibial nonunion secondary to a failed bone defect reconstruction in a 12-year-old girl. Rapid healing was obtained in both cases. In the light of the data presented, we consider VTPG as a valuable surgical option for the treatment of complex bone nonunions in children.

Vascularized thumb metacarpal periosteal pedicled flap for scaphoid nonunion: An anatomical study and pediatric case report

“…Vascularized periosteal grafts are easy and quick to harvest at this young age, and the flap's elasticity permits it to readily conform to the recipient's bed configuration (Finley et al, ; Soldado et al, ). Previous vascularized periosteal grafts reported for the treatment of recalcitrant nonunion did not require nonunion‐focused bone grafting, as was true in our case (Finley et al, ; Qi et al, ; Soldado et al, ). With stable internal screw fixation, scaphoid waist nonunion with collapse and bone loss can be treated successfully using only a cancellous bone graft (Cohen, Jupiter, Fallahi, & Shukla, ).…”

“…This can be explained by the abundance of osteogenic stem cells located within the cambium layer (Finley, Wood, & Acland, ; Soldado et al, ). The cambium layer, in intimate contact with both the nonunion focus and the poorly‐vascularized surrounding tissues, may induce healing more efficiently than a vascularized bone graft (Soldado et al, ).…”

“…Several vascularized periosteal graft techniques have been reported recently as reliable techniques to enhance bone union in particularly‐unfavorable scenarios in children (Diaz‐Gallardo et al, ; Finley et al, ; Qi et al, ; Soldado et al, ), with excellent results treating bone nonunion (Diaz‐Gallardo et al, ; Finley et al, ; Qi et al, ; Soldado et al, ; Yuceturk et al, ). Vascularized periosteal grafts are easy and quick to harvest at this young age, and the flap's elasticity permits it to readily conform to the recipient's bed configuration (Finley et al, ; Soldado et al, ).…”

Unsuccessful vascularized fibular periosteal graft for treatment of femoral head osteonecrosis

“…Postoperative evolution was uneventful. Six months later, the decision was made to perform a modified vascularized fibular periosteal graft (VFPG) for the left hip, as justified by the stronger angiogenic properties in comparison to FVFG [5,6]. At that moment, the femoral head was classified as Ficat stage III with minimal collapse.…”

Surgery of False Joints of Long Tubular Bones in Children Using the Shape Memory Materials

“…radkevich.andrey@yandex.ru combination with cell technologies) as well as fixation by means of intramedullary osteosynthesis, plate metal structures in combination with the external fixation devices or without them [1,[4][5][6][7][8][9][10][11][12][13][14]. The results of these technologies' application are often not efficient due to insufficient bone regeneration properties in the damage area, the inevitability of the partial or complete transplant resorption.…”