In the past two decades, plastic surgeons have advanced to the forefront of spinal surgery, joining orthopedic and neurosurgeons in the multidisciplinary field of spino-plastics. As the global disease burden grows with an increased incidence of spinal pathologies, vascularized bone grafts (VBGs) define the current frontier of spino-plastic surgery. Vascularized bone grafting involves lifting segments of bone with the muscular attachments but without the inclusion of a named vessel. When compared to traditional nonvascular bone grafts and allografts, VBGs have come forward as a favored technique for complex spinal reconstruction due to the unique opportunity to capitalize on the relationship between the tendons and Sharpey's fibers which maintain blood flow to both the bone and muscular segments. This technique ensures robust autologous tissue rearrangement and also takes advantage of the osteoinductive properties of the bone segments, promoting adequate structural support and the perfusion necessary for efficient direct healing and fusion in intricate spine reconstructions. Another one of the many favorable qualities of VBGs is the diversity of sources available to surgeons. The review explores the role of VBGs in enhancing spinal fusion rates and minimizing morbidity compared to traditional approaches. Additionally, a detailed examination of six common VBG sources-the iliac crest, ribs, medial scapula, occiput, spinous processes, and clavicle is included, highlighting each graft's specific techniques and emphasizing the range of options available to spino-plastic surgeons.

BackgroundDegloving soft tissue injury is among the most devastating trauma types, especially when involving the lower extremities. This study aims to identify degloving soft tissue injury (DSTI) Patterns, Treatment, and Short-term Outcomes. MethodsThis is a prospective, cross-sectional, hospital-based study of patients with DSTIs over six months. ResultsFifty-six patients with lower extremity DSTIs were included. The mean age of the patients was. 29.2 years.Males were predominant (71.4 %). The common site for DSTIs is the dorsum of the foot. Fourteen patients with degloving injury to the foot dorsum had open fractures with type 3 A Gustilo classification. Participants with MESS 1 did not have underlying fractures. Patients with higher MESS scores experienced a more severe form of injury. Most of the patients presented late to plastic surgery services. Definitive management offered to the patients includes secondary intention, direct closure, SSG, and loco-regional flap. The loco-regional flaps used were random fascia-cutaneous, sural, saphenous, Lateral gastrocnemius, and medial gastrocnemius. Thirty-nine of the participants had no complications following management. The complications encountered include Surgical site infection, wound dehiscence, and partial graft or flap loss. These complications were managed by local wound care and a local flap. More extended hospital stay was observed in patients with low revised trauma scores. ConclusionLower extremity DSTIs are common injuries in Sudan, and it is management is challenging. DSTIs with underlying fractures are the most common pattern of injury, with the dorsum of the foot being the most commonly affected part. A multidisciplinary approach is essential for management.

PurposeTo determine and evaluate the distal forearm and wrist's cutaneous blood supply and vascular territories. MethodsFour cadaveric upper extremities were injected with a radiopaque, lead-based contrast agent through the brachial artery. After the lead-based contrast agent set, the cadaveric limbs underwent computed tomographic (CT) scanning to assess the perforators to the cutaneous skin of the distal forearm and wrist. High-resolution axial CT and three-dimensional reconstructions were generated to highlight perforating vessels stemming from their parent arteries. Subsequently, anatomic microdissections were performed to identify and trace the perforating vessels identified on CT. ResultsCT analysis and anatomic microdissection demonstrated that the dorsal surface of the distal forearm and wrist are supplied by numerous perforators stemming predominantly from the anterior interosseous artery with some anastomotic contribution from the posterior interosseous, radial, and ulnar arteries. Perforators from the radial and ulnar arteries supply the volar surface. There are large anastomotic networks formed between the perforating vessels. ConclusionsThe distal forearm and wrist have a robust anastomotic blood supply that has contributions from the anterior interosseous, posterior interosseous, radial, and ulnar arteries. Clinical relevanceThe extensive perforator-derived blood supply to the skin likely accounts for the excellent soft tissue healing potential of the wrist following surgery utilizing multiple incisions.

BackgroundSoft tissue and bone injuries in the lower extremities associated with high-energy trauma remain a formidable challenge to treat. The timing of the operation, the most suitable type of tissue, and the decision between local or free flap coverage remain under discussion. MethodThis prospective, cohort, multi-center study was conducted in Khartoum, Sudan, from April 2021–September 2021. The study included 70 patients. Data was collected using a questionnaire filled with patients after getting informed consent. ResultsMales were 53(75.7 %) and females were 17(24.3 %). Male to female ratio was 3.1: 1. The mean age of the patients was 27.2 ± 3.4 years. The indications for the use of fascia-cutaneous flap in the management of traumatic soft tissue injuries of distal legs were distal substance loss areas of the leg 55(78.6 %), bone exposure 60(85.7 %), open fracture 29(41.4 %), and tendon exposure 31(44.3 %). The type of fasciocutaneous flap used for the patients in this study was perineal artery flap in 20(28.6 %), sural flap in 19(27.1 %), anterior tibial artery perforator flap in 18(25.7 %), and posterior tibial perforator flap in 13(18.6 %) of the patients in 42(60 %) of the patients, no complications were reported. The reported complications were infection 16(5.7 %), distal flap necrosis 8(11.4 %) and total loss 4(5.7 %). ConclusionDespite advances in microsurgery and free flap use, a fascia-cutaneous flap is still a valid option for distal leg soft tissue reconstruction in settings where this service is unavailable. fasciocutaneous flaps are an excellent option for distal leg defects to cover soft-tissue defects, exposed bones, and tendons.

The free vascularized fibula transfer has become a widely utilized method in reconstructive surgery, with successful applications across various anatomical areas. The biological properties of the graft, including its ability to fuse with recipient bone, repair fractures, and remodel in new biomechanical environments, have been key to its efficacy. However, stable bone fixation is crucial for successful fusion and to prevent complications like non-union. While early approaches focused on minimally invasive techniques to preserve the fibula's vascular network, stable internal fixation has become favored in preventing complications. This article aims to systematically describe bone fixation options for vascularized fibula grafts in the upper limb based on extensive experience, recommending internal fixation over external methods, such as long plates for humerus reconstruction. Different osteotomy techniques are discussed, including intramedullary, transverse, and step cut, with considerations for biomechanics and patient demographics. The discussion emphasizes the importance of stable osteosynthesis for successful outcomes, particularly in early rehabilitation. Additionally, advancements in 3D printing offer personalized solutions in osteosynthesis device design, further enhancing surgical outcomes.