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Combined osteocutaneous microvascular flap procedure for extensive bone and soft tissue defects in the tibia
P K Donski1, U Büchler, R Ganz
1Dept of Plastic and Reconstructive Surgery, Inselspital, University of Bern, Switzerland.
Annals of Plastic Surgery
|May 1, 1986
Summary
Vascularized fibular grafts offer bone healing benefits for complex tibial defects. Combining these grafts with free flaps, like latissimus dorsi, enhances reconstructive options for extensive tissue replacement needs.
Area of Science:
- Orthopedic Surgery
- Microsurgery
- Tissue Engineering
Background:
- Vascularized bone grafts are indicated for large bone gaps, post-irradiation scarring, low-grade infections, and congenital pseudarthrosis of the tibia.
- Current microvascular procedures may not fully address extensive bone and skin replacement requirements.
- Combining vascularized fibular grafts with free flaps can overcome limitations in complex reconstructive scenarios.
Observation:
- A study explored combining vascularized fibular grafts with free latissimus dorsi flaps in four patients.
- The procedure involved harvesting tissue units separately and performing microvascular connections.
- Anastomosis of peroneal vessels to thoracodorsal or scapular circumflex vessels was performed outside the operative field.
Findings:
- The combined composite tissue block's main vessels were anastomosed to a single pair of leg vessels.
- This approach facilitated and shortened the surgical procedure.
- The technique successfully augmented the vascularized fibular graft's benefits with those of a free flap.
Implications:
- This combined technique offers a viable solution for complex tibial reconstructions requiring both bone and soft tissue.
- It expands reconstructive possibilities in challenging cases previously unmet by standard microvascular procedures.
- Further research may validate this composite tissue transfer for broader clinical application in orthopedic and reconstructive surgery.