Algorithm of surgical treatment of large bone defects of long tubular bones by vascularized bone grafting

D Yu Ladutko,A V Gubicheva,O P Kezlya,Yu N Ladutko,А V Selitsky,A V Pekar,V N Podhaisky

doi:10.52581/1814-1471/78/06

Abstract

The purpose of this study was to develop a clinical classification of large defects of long tubular bones of the extremities and protocols for surgical treatment by vascularized bone grafting.Material and methods. The results of treatment of 51 patients with large defects of the long tubular bones of the upper and lower extremities were analyzed. In 25 cases, along with bone defects, there were significant defects of the soft tissues of the limb with trophic and scar changes. In order to replace the bone defect vascularized grafts were used: bone-muscular fibular, bone-cutaneous fibular, bone-cutaneous iliac, bone-cutaneous radial, bone-cutaneous tibial, and combined bone-cutaneous fibular with an allograft from the tibia. The results of treatment of patients were evaluated according to the clinical criteria of R. Johner, O. Wruhs (1983), proposed for the lower limb. The DASH questionnaire was use to evaluate the results of treatment for upper limb defects.The results and discussion. The classification is based on 4 variable criteria: the size, anatomical localization of the bone defect, the size of the soft tissue defect and the shortening of the damaged limb segment. The size and anatomical location of the defect in the long tubular bone is important in choosing a bone flap. Based on the anatomical localization of the bone defect, soft tissue damage and limb shortening, the patients were classified into 4 types. The first 3 types were divided into 2 subtypes, depending on the size of bone damage and soft tissues defect of the limb. Based on the proposed classification, we have developed protocols for microsurgical reconstruction of large bone defects of the extremities for each subtype of bone defect.Conclusion. The application of the developed clinical classification of large bone defects of long tubular bones and protocols for their surgical treatment by vascularized bone grafting made it possible to restore limb function in 96% of cases.

Highlights

На основе предлагаемой классификации мы разработали протоколы микрохирургической реконструкции крупных костных дефектов конечностей для каждого подтипа костного дефекта
The purpose of this study was to develop a clinical classification of large defects of long tubular bones of the extremities and protocols for surgical treatment by vascularized bone grafting
Based on the proposed classification, we have developed protocols for microsurgical reconstruction of large bone defects of the extremities for each subtype of bone defect

Summary

Introduction

В основу классификации включены четыре переменных критерия: размер, анатомическая локализация костного дефекта, величина дефекта мягких тканей и укорочение поврежденного сегмента конечности. Размеры и анатомическое расположение дефекта в длинной трубчатой кости важно учитывать при выборе костного лоскута. На основании анатомической локализации костного дефекта, сопутствующего повреждения мягких тканей и укорочения конечности пациенты были классифицированы на четыре типа. Первые три типа делятся на два подтипа в зависимости от размеров повреждения костной и покровных тканей конечности. На основе предлагаемой классификации мы разработали протоколы микрохирургической реконструкции крупных костных дефектов конечностей для каждого подтипа костного дефекта. Применение разработанной клинической классификации крупных костных дефектов длинных трубчатых костей и протоколов их хирургического лечения методом васкуляризированной костной пластики позволило восстановить функцию конечности в 96% случаев. Ключевые слова: Конфликт интересов: Прозрачность финансовой деятельности: Для цитирования: сегментарные дефекты длинных трубчатых костей, васкуляризированные костные трансплантаты. The purpose of this study was to develop a clinical classification of large defects of long tubular bones of the extremities and protocols for surgical treatment by vascularized bone grafting

Objectives

Methods

Findings

Conclusion