Floor plan - 2013 Annual Meeting - American Association for Hand ...

ASRM SCIENTIFIC PAPER PRESENTATIONS:
LOWER EXTREMITY
Vascularized Fibula Flap Onlay for Salvage of Pathologic Long-Bone Fracture
Institution where the work was prepared: Mayo Clinic, Rochester, MN, USA
Jeffrey B. Friedrich, MD; Steven L. Moran; Allen T. Bishop; Christina M. Wood; Alexander Y. Shin; Mayo Clinic
INTRODUCTION:
Long bone pathologic fractures, especially when radiation-induced, represent a significant and difficult entity to treat. The ultimate goal
of treatment is limb salvage, however, there are no treatment methods that guarantee bony healing. Frequently, immobilization or open
reduction and fixation are unsuccessful. In recent decades, the vascularized fibula flap has revolutionized skeletal reconstruction, including
that of the long bones. One treatment option for long-bone pathologic fracture is an onlay free vascularized fibula flap spanning
the fracture site. The purpose of this study is to report the results of onlay vascularized fibula flaps for pathologic long bone fractures,
and to determine the clinical outcomes, postoperative functional status, and complications of this method of reconstruction.
MATERIALS/METHODS:
A tumor registry review was conducted to search for patients who underwent long bone pathologic fracture reconstruction with the
onlay vascularized fibula flap. These patients' records were analyzed for details of reconstruction; time to bony union; subsequent surgeries;
clinical and functional outcomes; and complications associated with flap harvest and reconstruction.
RESULTS:
Twenty-five patients met criteria for this study. Twenty-one patients demonstrated bony fracture union at an average of 11 months following
fibula flap onlay reconstruction. All 4 of the patients whose fibular flap failed to demonstrate bony healing later obtained limb salvage
following subsequent procedures. Two patients who had experienced bony union ultimately required amputations for reasons unrelated
to the fibular reconstruction. Overall limb salvage was possible in 23 patients (92%). Twelve of 25 patients achieved a good or excellent
functional outcome as judged by a common oncologic reconstruction functional outcome scale. Thirteen patients had a fair or fail outcome.
Post-surgical complications were common in this group of patients, with a total of 22 distinct complications (88% incidence).
CONCLUSION:
This study demonstrates that pathologic long bone fracture salvage with an onlay vascularized fibula flap enables limb salvage in a majority
of patients. The incidence of postoperative complications is high, and must be weighed against the potential morbidity of limb loss.
Microvascular Bone Flap Prefabrication: Preliminary Results in an Animal Experimental Model
Institution where the work was prepared: Div of Plastic Surgery - University of Modena and Reggio Emilia, Modena,
Italy
Alessio Baccarani; Giovanna Petrella; Pietro Loschi; Massimo Pinelli; Giorgio De Santis; University of Modena and
Reggio Emilia
INTRODUCTION:
Bone defects still represent a significant challenge to the reconstructive surgeon. Despite major advancements in the field of biomaterials,
autologous bone grafts are to be considered the gold standard for reconstructing extended bony defects. Our study was designed
to develop a pre-fabricated bone flap in an animal model, starting from a predetermined-shape biocompatible scaffold (BS), a vascular
pedicle and different types of autologous stem cells.
METHODS:
Thirty New Zealand rabbits (male, weight range from 1.8 to 2.4 kg) were used and divided in three groups (10 rabbits each). In group 1
(control group) a 7 mm diameter biocompatible scaffold (xenogenic decellularized and deproteinized bone) was inset across the rabbit's
femoral pedicle and then wrapped into a silicon sheet. In group 2 the same BS was inset and 0.5 cc of autologous bone marrow
(BM) were added. In group 3 the same BS system was added with 1.5*106 autologous rabbit adipose-derived stem cells (ASCs) in 0.5
cc hyaluronic acid matrix suspension. After 16 weeks all implants were harvested as micro-flaps and then analized with microradiograms
(Micro X-Ray, Italstructure, Como, Italy) and by histology (5 mm sections, Toluidine Blue and Gomori staining).
RESULTS:
At microradiographic analysis all the inset scaffolds showed decreased density with respect to the same pre-operatory non-implanted
scaffolds. Group 2 implants showed additionally a significant change in the finest trabecular morphology. Histological analysis showed
in group 1 implants an abundant connective tissue deposition with angiogenesis, and frequent bone resorption sites. In group 2
implants, osteogenesis was found. Active osteoblasts were assessed together with vital osteocytes. Group 3 implants did not differ
much histologically from the control group, but were characterized by a more intense granulocytic inflammatory reaction.
CONCLUSIONS:
Bone marrow derived stem cells are able to promote a faster osteogenesis process in this microsurgical experimental model. Adipose
derived stem cells (ASCs) may promote the same process with longer latency. Microsurgical bone prefabrication may represent a possibile
reconstructive option in the future.
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