1/10. Use of a reversed-flow vascularized pedicle fibular graft for treatment of nonunion of the tibia.Ten patients with nonunion of the lower tibia were treated with a vascularized ipsilateral fibular graft, that was transferred distally and based on retrograde peroneal vessel flow. Eight patients were treated for congenital pseudarthrosis of the tibia; one had a nonunion subsequent to infection, and another patient had bone and skin loss due to infection. A posterior approach was used to expose the tibia and to harvest the fibula. Bone union and full weight-bearing were achieved in all cases by 9 months. The patients were followed-up for a mean of 1.8 years (range: 1.5 to 3 years).- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/10. Supracondylar femur nonunion associated with previous vascular repair: importance of vascular exam in preoperative planning of nonunion repair.One case of a Gustilo type 3C open OTA 33A-1 supracondylar femur fracture with superficial femoral artery injury that underwent reverse saphenous vein graft repair and open reduction and internal fixation with a retrograde femoral nail is reviewed. The fracture progressed to a hypertrophic nonunion despite 2 bone-grafting procedures and a nail dynamization. Upon referral for revision of the nonunion, a vascular examination revealed a well-perfused extremity with slightly diminished pedal pulses. An arteriogram was ordered that revealed an intraosseous aneurysm associated with the nonunion site and vascular repair. In a joint procedure with vascular and orthopedic surgeons, the previous vessel repair was mobilized, the aneurysmal feeder vessels were ligated, and the nonunion was revised with bridge plating and iliac crest autograft. The nonunion healed uneventfully, and the patient shows no signs of vascular compromise at the 2-year follow-up. The importance of the preoperative vascular assessment is emphasized, and the literature is reviewed.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
3/10. Arteriovenous shunts in free vascularized tissue transfer for extremity reconstruction.Local vessels are occasionally unsatisfactory donor choices for vascularized tissue transfer in extremity reconstruction. Construction of a temporary arteriovenous loop facilitates not only tension-free anastomoses outside the zone of injury but also affords vascular distention at physiological pressures, an opportunity to verify vein graft patency before tissue transfer, and presumably a decrease in the ischemia time of the vein graft itself. We reviewed the cases of 25 consecutive patients who underwent upper and lower extremity reconstruction facilitated by temporary arteriovenous shunts. In single-stage procedures, greater or lesser saphenous veins were used; the venous end was left in situ in its bed in 17 patients and the entire vein harvested freely in 8. The most common destination was the leg (11), followed by the thigh (7), foot (2), sacrum (2), knee (1), arm (1), and forearm (1). There were three (12%) failures. We conclude that construction of temporary arteriovenous shunts using vein grafts is a productive adjunctive technique in vascularized tissue transfer where additional pedicle length is needed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/10. A new method for monitoring circulation of grafted bone by use of electrochemically generated hydrogen.The patency of the anastomosed blood vessels in a free vascularized bone graft is difficult to ascertain during the early postoperative stage. For this purpose, the local blood flow was measured by means of electrochemically generated hydrogen. Although only three cases have been tested thus far, the method proves to be a simple and useful monitor of the blood flow in a free vascularized bone graft.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/10. Intraosseous blood supply of the capitate and its correlation with aseptic necrosis.Isolated capitate fractures that result in the development of aseptic necrosis of the proximal pole are uncommon. Five patients were treated who developed aseptic necrosis of the proximal pole. Four had a history of trauma with radiographic evidence of nonunion. in vitro arterial injection studies were done to correlate clinical problem with intraosseous capitate vascularity. Palmar vessels were found to contribute the majority of the blood supply to the capitate. Three patterns of intraosseous blood supply were seen. In each pattern, the proximal pole received its blood supply exclusively in a retrograde fashion across the capitate waist analogous to the proximal scaphoid. Aseptic necrosis without collapse of the proximal pole was successfully managed with curettage and bone grafting in three patients. The remaining two patients, with collapse and pericapitate degenerative changes, were managed with intercarpal fusion.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/10. Free vascularized bone transplants in problematic nonunions of fractures.Three cases with nonunion of long bones and problems of bone loss or infection, when conventional bone graft would probably not have been successful, were treated successfully by free vascularized bone transplant to provide a vascular bed in the nonunion site and internal splint, the donor bone being the composite rib graft based on posterior intercostal vessels and proximal fibula based on its peroneal vascular pedicle. The operative technique was divided into five stages, and each stage posed different problems at the donor and recipient areas and vessel anastomoses. Despite these disadvantages, all three cases proceeded to solid bony union in less than 4 months after surgery. Thus the patients were able to be rehabilitated early to retain satisfactory limb function within a relatively short period of time.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
7/10. Microvascular osteocutaneous groin flap in the treatment of an ununited tibial fracture with chronic osteitis. A case report.A 37-year-old man with an ununited tibial fracture combined with a significant skin defect underwent a microvascular transfer of an island osteocutaneous flap of groin skin and iliac crest bone. The bone component of the flap was shown to be a living transplant by the observation of brisk cancellous bone bleeding when the flap was isolated on its vascular stalk; by rapid fracture healing (weight-bearing 15 weeks postoperatively); and sequential bone scan investigations. Various aspects of the flap blood supply, particularly to bone, are discussed, and reference is made to the use of a more suitable vessel system.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/10. arteriovenous fistula complicating operative treatment of an ununited tibial fracture.We report the case of a traumatic arteriovenous fistula of the peroneal vessels following a bone graft operation for an un-united tibial fracture. The fistula was recognised as a result of a bruit at the site of the fracture. The fistula was repaired and the fracture subsequently united.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/10. Vascularized periosteal bone graft from the supracondylar region of the femur.Free, vascularized thin corticoperiosteal grafts and small periosteal bone grafts harvested from the supracondylar region of the femur are described. These grafts are nourished from the articular branch of the descending genicular artery and vein. Thin corticoperiosteal grafts consist of periosteum with a thin layer of outer cortical bone and include the cambium layer, which has a better osteogenic capacity. This graft is elastic and readily conforms to the recipient bed configuration. Thin corticoperiosteal grafts were used to treat 11 patients with fracture non-union of an upper extremity that had no massive bone defects. Early, rapid union occurred in all patients except three: one in which the anastomosed vessel became obstructed and two in which the internal fixation of the fracture was unsecured. The small bone grafts consist of periosteum, full thickness cortex, and the underlying cancellous bone. This graft can be successfully harvested without disturbing the vascularity, unlike the currently used vascularized bone grafts. This graft was used to treat three patients with avascular necrosis of the body of the talus and could prevent the necrotic talus body from progressive collapse in patients in early stages of the disease. One patient with an infectious bone defect of the first metatarsal bone was successfully treated by vascularized bone graft with an accompanying skin flap.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/10. Peroneal osteocutaneous flap raised on reconstructed popliteal artery for delayed union following open tibial fractures.Two cases of delayed union following type IIIC open tibial fracture were treated by a pedicled peroneal osteocutaneous flap raised on reconstructed popliteal vessels. dissection of the peroneal vessels from the already traumatized extremity was tedious, but this technique provided a reliable vascularized skin and bone graft that was indispensable for the fracture healing. Peroneal osteocutaneous flaps raised on the reconstructed popliteal artery have not been reported to date; they appear to be a good alternative to free osteocutaneous flaps for non-union of the proximal tibia.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
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