Vascularized bone grafts to the upper extremity. Indications and technique.
Vascularized bone grafts to the upper extremity. Indications and technique.
复制标题
上肢血管化骨移植。
作者：
Michelle Gerwin;Andrew J. Weiland
具有完整血管蒂的大量自体骨移植物减少了治疗节段性骨缺损所需的骨愈合和固定时间。这些技术已被证明是有效的治疗创伤或肿瘤切除术后相对无血管床超过6厘米的节段性缺损。此外，在上肢，游离带血管骨移植物正处于发育阶段，用于重建骨骺停止和先天性桡骨棒手。与传统技术相比，自由血管化骨移植存在缺点。例如，游离带血管的腓骨移植需要一个微血管技术熟练的团队，手术时间长（6至10小时），并且要牺牲一条通往下肢的主要血管。然而，如果吻合失败，游离带血管的腓骨将作为传统的骨移植物，从而最大限度地减少不良反应。我们认为，通过适当的患者选择，适当的骨缺损评估和准备，细致的微血管吻合，正确的固定和固定移植物，对于那些无法使用常规方法的大骨缺损患者，可以取得良好的效果。
Massive autogenous bone grafts with an intact vascular pedicle decrease the time to bony union and immobilization required for treatment of segmental bony defects. These techniques have been shown to be effective in treatment of segmental defects of more than 6 cm after trauma or tumor resection in relatively avascular beds. Additionally, in the upper extremity, the free vascularized bone graft is in the developmental phase for employment in the reconstruction of epiphyseal arrest and congenital radial club hand. There are disadvantages to free vascularized bone transfers compared with conventional techniques. For example, a free vascularized fibular transfer requires a team skilled in microvascular technique, a long operative time (6 to 10 hours), and the sacrifice of a major vessel to the lower extremity. If the anastomosis fails, however, the free vascularized fibula will act as a conventional bone graft, thereby minimizing adverse effects. We think that by proper patient selection, appropriate evaluation and preparation of the bony defect, meticulous microvascular anastomosis, and correct fixation and immobilization of the graft a good outcome can be achieved in those patients with large bony defects that defy the use of conventional methods.