Bone Graft Reconstruction Research Articles

Plastic Surgery Contributions to the World Wars: Historical Foundations for Modern Craniofacial Techniques.

Plastic surgery played a crucial role during the World Wars. Surgeons dedicated their careers to reconstructing facial injuries and residual deformities incurred during combat. Times of unprecedented trauma led to rapid innovation in plastic surgery, with invaluable impact on practice today. Pioneers such as Harold Gillies are well-known for their work. There are numerous additional contributors who deserve wider recognition. A literature review was performed to identify key surgeons who treated soldiers' craniofacial injuries during World Wars I and II. Biographical information, country of practice, and technical contributions to plastic surgery were compiled. Nineteen plastic surgeons were identified who contributed significantly to craniofacial surgery during the World Wars. These surgeons were: Albéric Pont, Archibald Mcindoe, Arthur Mowlem, Harold Gillies, Hippolyte Morestin, James Barrett Brown, Jaques Joseph, Johannes Esser, John Staige Davis, John Reese, Otto Lanz, Paul Tessier, Robert Ivy, Suzanne Blanche Gros Noël, Thomas Kilner, William Kelsy Fry, Varaztad H. Kazanjian, Vilray P. Blair, and Vladimir Petrovich Filatov. Fourteen were active during WWI. Nine were active during WWII. Notable technical developments were made in maxillofacial fracture fixation, bone grafting, rhinoplasty, dental prosthetics, flap-based coverage, skin grafting, and burn reconstruction. Plastic surgeons played an unheralded role in managing the disfiguring craniofacial injuries of World Wars I and II. By treating tens of thousands of war victims, these surgeons contributed not only to the rehabilitation of soldiers but also to the advancement of craniofacial surgery and the establishment of plastic surgery as a distinct subspecialty.

Long-Term Outcomes of Primary Cemented Total Hip Arthroplasty with Acetabular Bone Graft for Protrusio Acetabuli: Minimum 10-Year Follow-Up.

Background: This study reports the long-term survivorship of primary total hip arthroplasty (THA) for protrusio acetabuli. Methods: Patients undergoing THA utilising cement and bone graft acetabular reconstruction for protrusio acetabuli in a university teaching hospital during the period 2003 to 2014 were included. Kaplan-Meier survival estimates were calculated with 95% confidence intervals (CI) up to 15 years following surgery. PROMs were collected pre- and post-operatively for hip-specific function (Oxford Hip Score [OHS]) and health-related quality of life (HRQoL) using the EQ-5D-3L. Results: 129 consecutive THAs (96 patients) performed for protrusio acetabuli were identified (median age 69, IQR 61-75; female 115 [89.1%]; 38 [29.5%] inflammatory arthritis) with a mean follow-up of 15.7 years (range: 10.1-20.1 years). At the final follow-up, fifty-six (43.4%) patients had died and there were eleven (8.5%) reoperations, of which eight (6.2%) involved the revision of the acetabular component. The fifteen-year Kaplan-Meier any-reoperation survival estimate was 91.3% (95% CI 85.9-97.0). When considering all-cause acetabular revision only, the 15-year survival estimate was 93.1% (95% CI 88.2-98.3). The median pre-operative OHS improved significantly from baseline to 1 year post-THA, beyond the minimal important change (mean difference 28, 95% CI 25-30, p < 0.001). Similarly, there were clinically relevant improvements in HRQoL at 1 year post surgery (mean difference 0.10, 95% CI 0.06-0.15, p < 0.001). Conclusions: This study demonstrates that primary cemented THA utilising acetabular bone graft for reconstruction in patients with protrusio acetabuli was associated with 15-year survival rates of 93.1% and clinically relevant improvements in hip-specific function and HRQoL.

Surgical correction of radially deviated Wassel type III thumb polydactyly: a prospective case series.

We report our experience with correction of radially deviated Wassel type III thumb polydactyly. After comprehensive assessments from preoperative radiographs, physical examinations and intraoperative reports, we corrected the metacarpophalangeal joint in 34 cases of radially deviated Wassel type III thumb polydactyly. Opening-wedge osteotomies combining bone graft and soft tissue reconstruction were used in 28 cases and soft tissue reconstruction only in six cases. Absorbable sutures were used instead of traditional Kirschner (K)-wires to fix the bone grafts. Patients were followed up for 12-78 months (mean 47 months). According to the Tada scoring system, 25 patients achieved good results, seven fair results and two poor results. Our modified technique for correcting radially deviated Wassel type III thumb polydactyly yielded satisfactory results. Continued follow-up and further studies will contribute to a better understanding of the long-term efficacy and potential refinements of this technique.Level of evidence: IV.

Direct anterior bone block grafting for treatment of bone defects and dysplasia of the coronoid process

The aim of the surgery was to treat an elbow instability caused by critical coronoid bone loss (CCBL), lateral ulnar collateral ligament (LUCL) insufficiency,and general hyperlaxity by performing adirect anterior coronoid bone graft (CBG) and LUCL reconstruction in the same setting. In cases with CCBL isolated ligament reconstruction harbors ahigh failure rate, necessitating supplementary bony procedures. The diagnosis of CCBL is confirmed through lateral radiographs and further quantified through computed tomography (CT) imaging. Objective assessment of instability is conducted with standardized arthroscopic tests. Performing an anterior approach for CBG offers distinct advantages, notably in terms of achieving precise positioning of plates and screws and providing access to the proximal radioulnar joint. Usual contraindications to surgery, coronoid bone loss less than 40%. The surgical procedure is thoroughly illustrated with avideo of the operation that can be accessed online: reconstruction of the LUCL with asemitendinosus allograft, harvesting of the graft from the iliac crest, exposure of the coronoid process with adirect anterior approach, freshening up of the graft bed. Temporary fixation of the graft with aKirschner wire. Assessment of joint congruency, stability and range of motion (ROM) prior to definitive fixation with a2.4 mm buttress plate and screws. Nonsteroidal anti-inflammatory drugs (NSAID) to prevent heterotopic ossification. Elbow mobilization in pronation from day1 with an overhead motion protocol. Removable splint for 4weeks, free mobilization at 6weeks, return to sport at 3months. Durable elbow stability was achieved along with free ROM and high patient satisfaction.

Evaluation of the success of anterior iliac crest harvested bone graft in reconstruction of different jaw defects: a retrospective study

Aims: The aim of this study was to evaluate the success of bone grafts obtained from the anterior iliac crest, the recipient and donor site complications in the reconstruction of jaw defects caused by different etiologies in maxillofacial surgery. Methods: A retrospective cohort study was conducted at the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Erciyes University between 2012-2022. It included patients with iliac crest harvested bone grafts due to jaw defect with full records. The primary predictive variable was the type of jaw defect. The primary outcomes were the presence of complications at donor and recipient sites. Secondary outcomes were length of hospital stay and type of complications at donor and recipient sites. The obtained data were analyzed with Kruskal Wallis Test, Pearson’s chi-square test and Fisher’s exact test. Results: This study included 104 (44 female, 60 male) patients. Complication rate was 21.15%. There was no statistically significant relationship between the type of jaw defect and the success of iliac bone grafts (p=0.257). The most common recipient site complication was resorption in alveolar atrophy groups, the dehiscence in alveolar cleft groups, infection in other reason groups. There was no statistically significant relationship between type of jaw defect and complication types (p=0.524). Conclusion: The results of the study demonstrate that general success rate was 78.85% in jaw reconstruction with anterior iliac crest harvested bone grafts. The major complication rate causing total graft loss was 13.46%. There was no statistically significant relationship between the type of jaw defect and the success of iliac bone grafts.

Clinical and Radiographic Outcomes and Graft Incorporation Rate Assessed by CT Scan After Reverse Shoulder Arthroplasty With Glenoid Structural Bone Graft Reconstruction.

Reverse total shoulder arthroplasty (RTSA) with structural bone graft has been described as a technique in addressing glenoid bony defects. Studies have demonstrated acceptable outcomes with structural autograft or allograft. However, most of these studies are relatively small and rarely evaluate bone graft incorporation with CT scan. The aim of this study was to assess clinical and radiographic outcomes and report graft incorporation assessed on CT scan after RTSA where structural bone autograft or allograft was used to reconstruct the glenoid. From May 2011 through June 2016, 38 patients underwent RTSA with structural bone graft. Of these, 35 were available for a minimum 2-year follow-up and retrospectively enrolled. From July 2016 through February 2019, 32 patients undergoing RTSA with structural bone graft were prospectively enrolled. Preoperative and postoperative American Shoulder and Elbow Surgeons and visual analog scale (for pain) scores and radiographs were obtained. CT scan was obtained at least 1 year postoperatively. Thirty-five patients were enrolled retrospectively (52.2%) and 32 prospectively (47.8%). Autograft was used in 46 cases (68.7%) and allograft in 21 cases. The mean American Shoulder and Elbow Surgeons score improved from 33.1 (SD 18.5) to 78.2 (SD 22.4), with P < 0.0001. On postoperative radiographs, 63 cases (94.0%) showed stable RTSA constructs while four cases (6.0%) developed glenoid baseplate subsidence. Postoperative CT scan demonstrated complete graft incorporation in 45 cases (90.0%) while partial incorporation was noted in 4 cases (8.0%), and in 1 case (2.0%), there was no graft incorporation. No correlation was observed between baseplate subsidence and graft type (autograft versus allograft) or primary versus revision surgery. Reverse shoulder arthroplasty with structural bone autograft and allograft is reliable for glenoid augmentation in patients undergoing RTSA in both primary and revision settings. Bony incorporation of autograft and allograft as evaluated on CT scan is predictably high.

The dental implant survival rate in 18 patients with post-operation revolutionary jaw reconstruction using free fibular flap, dental implants, and overdentures

Background/purposeThis retrospective study assessed the risks and complications associated with dental implants after jaw surgery and radiotherapy for large defects, highlighting challenges for reconstructive surgeons and prosthetic dentists. Materials and methodsFrom 2002 to 2008, National Taiwan University's Department of Maxillofacial Surgery used preoperative stereolithographic models and microvascular flaps for mandibular reconstruction in 18 patients with defects from ameloblastoma or advanced gingival cancer. They received free fibular flap grafts, followed by 46 osseointegrated dental implants. Patient outcomes, monitored for up to 60 months, were assessed through clinical and radiographic evaluations of implant success. ResultsThe overall survival rate of dental implants following tumor surgery and radiotherapy was 84.8%. Seven implants failed due to peri-implantitis (3), tumor recurrence (2), and osteoradionecrosis (ORN) (2). The ameloblastoma group did not contribute to implant failure, with 4 implant failures in the stage III gingival cancer group, and 3 implant failures in the stage IV gingival cancer group. ConclusionFollowing segmental mandibulectomy for mandible lesions, free fibular bone graft reconstruction restored mandible continuity, while subsequent dental implantation and overdenture fabrication restored occlusion and aesthetics for patients. Besides considering treatment strategies for ameloblastoma groups, similar approaches can be extended to oral cancer patients undergoing post-operative reconstruction. However, additional considerations (peri-implant soft tissue condition, tumor recurrence, ORN, etc.) are necessary for oral cancer patients predisposed to dental implant failure post-surgery.

Autogenous structural bone graft reconstruction of ≥ 10-mm-deep uncontained medial proximal tibial defects in primary total knee arthroplasty

BackgroundManagement of uncontained medial proximal tibial defects during primary total knee arthroplasty (TKA) can be challenging, especially for defects ≥ 10 mm in depth. This study sought to assess the outcomes of autogenous structural bone grafts to address these defects.Materials and methodsIn this prospective study, patients with uncontained medial proximal tibial defects ≥ 10 mm in depth undergoing TKA were managed by autogenous structural bone grafts fixed by screws and were followed up for at least 36 months. Patients were followed-up clinically with Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Additionally, radiological follow-up was done to assess bone graft union and implant stability.ResultsThe study included 48 patients with a mean age of 69.2 ± 4.5 years. The mean body mass index (BMI) was 31.4 ± 3.7 kg/m2. The mean defect depth was 17 ± 3.6 mm. With a mean follow-up period of 52.2 ± 12.3 months, the median KSS improved significantly from 30 preoperatively to 89, P < 0.001. The median WOMAC score reduced significantly from 85 preoperatively to 30.5, P < 0.001. The mean ROM increased significantly from 73 ± 12.4 preoperatively to 124 ± 8.4 degrees, P < 0.001. The mean graft union time was 4.9 ± 1 months. No significant complications were reported.ConclusionsAutogenous bone graft reconstruction is a safe and effective method of addressing uncontained medial proximal tibial defects in primary TKA.Level of evidenceLevel IV.

СПОСОБ ЛЕЧЕНИЯ ЛОЖНЫХ СУСТАВОВ ЛАДЬЕВИДНОЙ КОСТИ ПУТЕМ ПРИМЕНЕНИЯ НАДКОСТНИЧНЫХ ЛОСКУТОВ НА МЕТАКАРПАЛЬНЫХ АРТЕРИЯХ

The purpose of the study: to improve the method of surgical treatment of patients with scaphoid nonunion. Material and methods: the results of treatment of 30 patients operated on for scaphoid nonunion of the hand, which arose after conservative treatment (not treatment) of fractures, surgical treatment for 2018-2021 were analyzed. The patients were divided into two groups: 15 patients with scaphoid nonunion who underwent free bone autoplasty as a surgical aid, fixation of bone fragments with a headless screw – a control group; 15 patients with fscaphoid nonunion, who underwent free bone autoplasty as surgical treatment, supplemented with non-free plastic surgery with a periosteal flap on the metacarpal artery – the main (experimental) group of patients. The possibility of using periosteal flaps isolated from the first and second metacarpal bones was evaluated. To assess the results of treatment, X-ray monitoring of scaphoid nonunion consolidation was used at 8, 12 weeks and 6 months after surgery; computed tomography of wrist joints was performed at 4 months after surgery in order to assess the degree of bone graft reconstruction. Hand function was assessed before and after surgery using the DASH Upper Limb Disability Questionnaire and the Visual Analog Pain Scale (VAS). Results of the study: in the experimental group, scaphoid nonunion consolidation was achieved in 13 out of 15 patients (86.6%) compared with the control group (10 out of 15 patients – 66.7%). According to the severity of the pain syndrome and the final functional result, comparable indicators were obtained in both groups. Discussion: given the small sample of patients who participated in the work, the study has moderate reliability. However, the data obtained allow us to hope for the effectiveness of the proposed method of surgical treatment used in patients of the main study group.

Comparison of the Outcome of Free Iliac Bone Graft and Vascularized Iliac Bone Graft in Reconstruction of Mandibular Defects: A Systematic Review

Comparison of the Outcome of Free Iliac Bone Graft and Vascularized Iliac Bone Graft in Reconstruction of Mandibular Defects: A Systematic Review

Finite element analysis of a customized coronoid prosthesis for traumatic coronoid deficiency

BackgroundTraumatic coronoid deficiency with persistent elbow instability is a challenging condition. Autologous bone graft reconstruction is often associated with a range of additional clinical problems and the outcome is often unpredictable. The purpose of this study was to design a prosthetic device that can reconstruct coronoid deficiency of any height and to evaluate its mechanical properties using finite element analysis. Materials and MethodsA customized coronoid prosthesis was designed based on image registration, automatic measurement and computer-aided design. After pilot study and sample size calculation, image data collected from six patients who underwent bilateral complete upper extremity CT scans were reconstructed. The test was divided into three groups: coronoid intact, prosthesis and autograft. Regan-Morrey type II and autologous olecranon osteotomy models were established. The prosthesis and autogenous olecranon were assembled to the coronoid base. Stress was applied axially along the proximal humeral diaphysis and implant micromotion and contact mechanics of the humeroulnar joint were measured at 30°, 45°, 60° and 90° of joint flexion respectively. ResultsAt all flexion angles, the maximum stress on the coronoid articular surface was significantly reduced in the prosthesis and autograft groups, with the reduction being more significant in the latter (P < 0.001). With increasing flexion, the maximum stress at the coronoid articular surface increased significantly after autograft reconstruction (7.2 to 68 MPa, P < 0.001), whereas the humeroulnar joint obtained a similar contact mechanics pattern to that of the control group after prosthetic reconstruction. As the flexion angle increased, the relative micromotion of both the prosthesis and autograft increased significantly (0.5-1.6 vs 0.2-1.2, Pmeasure time < 0.001, Pgroups < 0.001). Contact pressure and center-of-force paths of the humeroulnar joint experience abrupt stress changes at approximately 60° of flexion. ConclusionThe contact stress pattern in the humeroulnar joint is similar in prosthesis and intact coronoid groups. Autograft reconstruction increases contact stresses at the articular surface and alters the joint center-of-force path. The “stress surge phenomenon” in the humeroulnar joint surface before and after 60° of flexion may be one of the mechanisms of traumatic elbow degeneration.

A comparative study of reconstruction modalities after knee joint-preserving tumor resection: reconstruction with a custom-made endoprosthesis versus reconstruction with a liquid nitrogen-inactivated autologous bone graft

BackgroundThis study evaluated the feasibility, complications, graft survival rate, and clinical outcomes of joint-preserving resection using a custom-made endoprosthesis and liquid nitrogen-inactivated autologous bone graft reconstruction in patients with malignant bone tumors around the knee joint.MethodsWe retrospectively analyzed 23 consecutive patients who underwent joint preservation surgery between 2008 and 2018 at our center. The study cohort included 13 patients who underwent custom-made endoprosthesis reconstruction and 10 who underwent liquid nitrogen-inactivated autologous bone graft reconstruction. The resected bone length, distance between the resection line and the joint, intraoperative blood loss, operation time, complications, and MSTS were compared between the two groups.ResultsThe median follow-up time was 68.5 months in the endoprosthesis group and 65.3 months in the inactivated autograft group. There were no significant differences in baseline characteristics, resected bone length, distance between the resection line and the joint, or intraoperative blood loss between the two groups. The operative time was longer in the inactivated bone graft group than in the endoprosthesis group (p < 0.001). The endoprosthesis group had more complications (six patients) and reoperations due to complications (five) than the inactivated autograft group (one), but there was no significant difference in the incidence of complications between the two groups (p = 0.158). The inactivated autograft group had one patient with type 1b complications, while the endoprosthesis group had one with type 1b complications, one with type 2b complications, and one with type 4a complications. One patient in the endoprosthesis group with type 5a complications experienced two soft tissue recurrences. The overall 5-year survival rate was 86.5% and the graft survival and final limb salvage rates were 100% in both groups. After the follow-up period, the mean MSTS scores were 91% ± 7% in the endoprosthesis group and 94% ± 6% in the inactivated autograft group, with no significant difference (p = 0.280).ConclusionJoint-preserving resection is a reliable and effective tumor resection method that can achieve good postoperative function. There were no significant differences in the incidence of complications, overall survival rate, or graft survival rate between the two groups.

Nonvascularized bone grafts: how successful are they in reconstruction of segmental mandibular defects?

ObjectiveSegmental mandibular defects can occur due to various etiologies, including trauma and tumor resection. Reconstruction should provide adequate support for subsequent dental rehabilitation and allow for proper occlusion. Non-vascularized bone grafts have been used for reconstructing mandibular defects in cases where vascularized grafts were not feasible. The objective of this study was to assess the success rate of these grafts in reconstruction of segmental defects of various sizes in the mandible. Study DesignFifty patients were included in this retrospective chart review. Length of the grafts varied from 3 to 20 cm and patients were followed-up from 4 to 80 months. Fifteen grafts were harvested from anterior iliac crest, 23 from posterior iliac crest, 9 grafts were a combination of either with costochondral graft, and 3 were solely allografts. Bone morphogenetic protein was utilized in 41 cases as an adjunct. ResultsSuccess was defined as continuity of bone clinically and radiographically at a 4-month follow-up. Non-vascularized bone grafting was successful in %90 of cases. Complications were observed in %34 of cases, of which the most common were infection followed by wound dehiscence. ConclusionOur study demonstrated substantial success rate with non-vascularized bone grafts in reconstruction of segmental mandibular defects.

Arthroscopic Xenograft With Cerclage Fixation: A Method for Glenoid Bone Loss Reconstruction With Cerclage Fixation Using a Specific Posterior Guide

Large glenoid bone defects are closely associated with high failure rates after arthroscopic Bankart repair in chronic anterior shoulder instability; therefore nowadays the glenoid bone grafting reconstruction procedure is strictly recommended. On the contrary, the optimal grafting procedure is still controversial because there is considerable concern about the resorption rate of allografts, donor site morbidity of the autografts, and sequelae caused by the use of metal fixation devices in proximity of the shoulder joint. We describe an all-arthroscopic technique for anatomic reconstruction of the glenoid that uses a previously shaped xenograft assembled with a metal-free fixation device using 2 ultra-high-strength sutures (FiberTape Cerclage System; Arthrex, Naples, FL), using a specific posterior guide (Arthrex, Naples, FL) in combination with upper third subscapularis augmentation.

Pure uniportal video-assisted thoracic surgery for treating thoracic tuberculous spondylitis: an initial case series of seven patients

BackgroundThe development of thoracic surgical techniques has provided a new avenue for treating thoracic tuberculosis. Moreover, microscopic treatment of spinal tuberculosis has attracted increasing attention, as it affords good visual access and reduces trauma. Traditional thoracoscopic treatment of spinal tuberculosis usually requires 2–3 passages, accompanied by a corresponding number of incisions. With a large number of conventional thoracoscopic surgeries performed, improved resolution of the microscopic field of view, effective hemostasis of the peripheral vessels using the ultrasonic knife, and many reports in the literature, thoracic tuberculosis can now be treated microscopically by creating a single channel. The aim of this study was to explore the feasibility and surgical technique for thoracic tuberculous spondylitis treatment via debridement and bone graft fusion surgery employing pure uniportal video-assisted thoracic surgery (VATS), combined with posterior internal fixation.MethodsSeven patients with relatively complete documentation were included in this study. All patients underwent lesion removal and bone graft reconstruction via uniportal VATS with posterior internal fixation. The mean patient age was 39.6 years. Surgical duration, blood loss volume, postoperative recovery time, and thoracic kyphosis angle were recorded.ResultsThe surgeries were successful with no severe postoperative complications. All patients were followed-up, and no recurrence of tuberculosis was observed. Imaging data, including computed tomography scans, confirmed the complete removal of the lesions. Additionally, bone fusion at the graft site was successful, no loss of the thoracic kyphosis angle was noted postoperatively, and the thoracic kyphosis angle improved.ConclusionsPure uniportal VATS yields satisfactory results and inflicts less trauma than previous surgical techniques. This technique also offers a reference value for treating thoracic tuberculous spondylitis.

Reconstruction of the Irreparable Proximal Scaphoid with Costo-Osteochondral Graft (Rib Graft)

Abstract Background Irreparable proximal pole fractures of the scaphoid remain a real challenge for the treating handsurgeon. Standard salvage options include 4-corner fusion or proximal row carpectomy. These procedures limit the range of motion and have a high rate of conversion to total wrist fusion. The two current biological reconstructive options are the rib graft or the vascularized femoral trochlea osteocartilaginous free flap. In addition, there is the prosthetic semi-replacement arthroplasty using the pyrocarbon adaptive proximal scaphoid implant (APSI). Aims To present our series of patients with non-reconstructable proximal scaphoid nonunion/fracture (not suitable for conventional bone graft reconstruction) who were treated by the rib graft technique. Methods Our case series of 21 patients treated between March 2013 and January 2019 will been presented (median follow-up 29 months). The surgical technique will be described and crucial technical steps explained. The mean age at surgery was 26 years (SD 5.8) and the median time between injury and rib graft surgery was 2 years (IQR 1.7–3.6). The median postoperative follow-up was 29 months (IQR 19.5–42.4). Results All patients returned to their pre-surgical occupation. Significant differences were found in active wrist movements, grip strength, QuickDASH and PRWE pain scores. Union was seen in all 21 patients. The postoperative capitolunate angles were within normal limits. 17/21 patients showed no progessive postoperative osteoarthritic changes, while 4/21 showed slight progression. Progressive ossification of the graft was noted in 14 /21 patients. No donor site complication occurred. One patient failed and underwent excision of the scaphoid and fourcorner fusion 9 months after the rib graft. At the time of revision, the graft was clinically united. We found statistically significant improvements in QuickDASH and PRWE. Conclusions Our results suggest that reconstruction of the irreparable proximal pole scaphoid nonunion with costo-osteochondral graft reconstruction (rib graft) is a reliable and straightforward procedure in this challenging problem.

Introduction of temporomandibular joint and skull base combined reconstruction by autogenous bone graft.

This study introduces the application of autogenous bone graft for the reconstruction of temporomandibular joint (TMJ) and skull base combined defects. Patients treated with autogenous bone grafts for reconstruction of the TMJ and skull base were reviewed. All patients underwent virtual surgical design to confirm the osteotomies of the combined lesion and the selections of autogenous bone graft, fabrication of surgical templates to transfer the plan to actual operation, and reconstruction of autogenous bone graft for the TMJ and/or skull base. Surgical outcomes were assessed by clinical examinations and radiological data. Twenty-two patients were involved in this study. Ten patients underwent reconstruction of the skull base by a free iliac or temporal bone graft and preservation of the TMJ. Twelve patients underwent skull base reconstruction by the same methods and total reconstruction of the TMJ by half sternoclavicular joint flap or costochondral bone graft. No severe complications occurred after surgery. The occlusion relationship was stable and similar to that of the preoperative state. The pain and maximal interincisal opening were significantly improved by the 101.2-month follow-up. Autogenous bone graft is a good alternative for repairing the TMJ and the skull base structure and function. The study introduced the application of autogenous bone graft for the reconstruction of temporomandibular joint and skull base combined defect, which is a good way to repair the defect and restore the function.

Vascularized Bone Graft Reconstruction for Upper Extremity Defects: A Review.

Upper extremity reconstruction may pose clinical challenges for surgeons due to the often-critical, complex functional demands of the damaged and/or missing structures. The advent of vascularized bone grafts (VBGs) has aided in reconstruction of upper extremity (UE) defects due to their superior regenerative properties compared with nonvascularized bone grafts, ability to reconstruct large bony defects, and multiple donor site options. VBGs may be pedicled or free transfers and have the potential for composite tissue transfers when bone and soft tissue are needed. This article provides a comprehensive up-to-date review of VBGs, the commonly reported donor sites, and their indications for the treatment of specific UE defects.

Maxillary Ossifying Fibroma Managed Using Cosmetically Acceptable Facial Degloving Approach with Iliac Bone Graft Reconstruction.

Ossifying fibroma is benign, slowly expansile, painless, well defined fibro-osseous tumour composed of calcified products such as bone, cementum, or both [1]. We opted for a novel approach for the management of ossifying fibroma of maxillary region through scarless midfacial degloving approach with iliac bone graft reconstruction. A 20 years old young female presented with left sided facial swelling involving anterior wall of maxilla and lifting the ala of nose. CT and FNAC suggested a benign lesion. Surgery was performed to remove the tumour completely and managed with scarless midfacial degloving approach with iliac bone graft reconstruction. The iliac crest free flap is an optimal method for maxillary defect reconstruction. The main advantages of the flap are the large amount of bone provided, its height, and the possibility of including the internal oblique muscle [2].

Среднесрочные результаты применения метода аутопластики медиального дефекта большеберцовой кости при первичном эндопротезировании коленного сустава

Introduction Repair of a bone defect in primary total knee arthroplasty remains one of the most common tasks that must be addressed intraoperatively. Autologous bone grafting is a good biological option to preserve the bone tissue for conservative revision. The objective of the study was to analyze the results of autologous bone grafting of the medial tibial defect in primary total knee arthroplasty. Material and methods Results of autografting a bone defect with cancellous bone obtained when forming a groove for the intercondylar box of the femoral component of the tibia during primary total knee arthroplasty were retrospectively analyzed (main group, n = 31). The control group (n = 31) was formed by leveling the heterogeneous clinical parameters identified in the initial data using the PSM method. The mean follow-up period was 72 months. The Mann-Whitney and Wilcoxon tests were used for statistical data analysis. Lower limb realignment and bone graft reconstruction were evaluated radiographically, and KSS and WOMAC questionnaires were used for physical evaluation. Results There were no significant differences in the baseline and postoperative clinical conditions of the realigned lower limbs and the number of identified non-progressive radiolucent lines no greater than 2 mm in the groups. There were significant differences in the severity of varus deformity at baseline. Each group had one case of aseptic loosening of the tibial component. One patient of the comparison group had a late periprosthetic joint infection that was arrested with two-stage revision treatment. Discussion There were significant differences in the size of the varus deformity with no significant differences in the scores at the baseline between the groups. There were no differences in the realigned lower limbs and in the scores reported in the groups postoperatively. Conclusion The method developed was shown to be safe, affordable and effective. The result obtained was confirmed by absent differences in clinical and radiological outcomes between groups.