Abstract
BackgroundTo investigate the feasibility and clinical efficacy of free vascularized iliac bone flap based on deep iliac circumflex vessels graft for the treatment of osteonecrosis of femoral head (ONFH) in young adults.MethodsEighteen patients (19 hips) undergoing ONFH were included from January 2016 to May 2017. After the debridement of the necrotic bones, the contralateral vascularized iliac bone flap was designed and harvested before grafting, in which the deep circumflex iliac vessels and the transverse branch (or ascending branch) of the lateral circumflex femoral artery and their accompanying veins were anastomosed. X-ray was obtained at 1, 3, 6, 9, and 12 months respectively for evaluation of the bone flap healing. Hip function was evaluated with Harris hip score at 18 months postoperatively.ResultsNone of the patients is lost to follow-up. All the hips healed well except for four complications: one patient developed superficial wound infection, one patient had subcutaneous hematoma, and two patients developed anterolateral femoral cutaneous nerve injury. X-ray films at 12 months showed improvement in 13 hips (68.4%), five hips (26.3%) were unchanged, and one femoral head collapse with conversion to total hip arthroplasty (THA) at 14 months postoperatively (5.3%). Postoperative mean Harris hip scores were significantly improved compared to the preoperative results (P < 0.05).ConclusionFree vascularized iliac bone flap based on deep circumflex iliac vessels graft is an acceptable treatment option for young adult ONFH in mid-late stage with low conversion to THA rate at short-term follow-up.
Highlights
To investigate the feasibility and clinical efficacy of free vascularized iliac bone flap based on deep iliac circumflex vessels graft for the treatment of osteonecrosis of femoral head (ONFH) in young adults
With the development of small vessel anastomosis, free vascularized iliac bone flap based on deep circumflex iliac vessels graft has been widely used in the reconstruction of limb and maxillofacial bone defects, due to the better osteogenic ability and speed of bone healing compared to other bone flap graft methods [14]
We sought a group of patients with Treatment of osteonecrosis of femoral head (ONFH) to determine whether free vascularized iliac bone flap based on deep circumflex iliac vessels graft could result in (1) improved Harris hip scores, (2) good bone flap healing, and (3) a low incidence of surgical complications
Summary
To investigate the feasibility and clinical efficacy of free vascularized iliac bone flap based on deep iliac circumflex vessels graft for the treatment of osteonecrosis of femoral head (ONFH) in young adults. Multiple treatment protocols for ONFH have been followed a comparative analyses of the long-term follow-up results of various treatments for ONFH, confirmed that graft or transfer of the vascularized bone flap This method has some disadvantages including moved vascular pedicle and difficulties in iliac bone flap placement and transfer [9, 10]. With the development of small vessel anastomosis, free vascularized iliac bone flap based on deep circumflex iliac vessels graft has been widely used in the reconstruction of limb and maxillofacial bone defects, due to the better osteogenic ability and speed of bone healing compared to other bone flap graft methods [14]
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