Periosteal Stripping Research Articles

Reconstruction of full thickness lower eyelid defects using a lateral advancement flap with Z-plasty and periosteal strip

ABSTRACT Purpose To describe a single stage technique of reconstruction of full thickness lower eyelid defects using a lateral advancement flap and Z-plasty combined with a lateral periosteal strip. Methods A retrospective case series of six patients who underwent reconstruction using this technique is presented documenting surgical technique, clinical photographs and postoperative outcomes. Results All six patients demonstrated good eyelid position and cosmesis following reconstruction. Conclusion A lateral advancement flap with Z-plasty combined with a periosteal strip is an effective technique to close lower eyelid defects of up to eighty percent of eyelid width, providing a good structural and aesthetic outcome.

Spatial and temporal patterns in dynamic-contrast enhanced intraoperative fluorescence imaging enable classification of bone perfusion in patients undergoing leg amputation.

Dynamic contrast-enhanced fluorescence imaging (DCE-FI) classification of tissue viability in twelve adult patients undergoing below knee leg amputation is presented. During amputation and with the distal bone exposed, indocyanine green contrast-enhanced images were acquired sequentially during baseline, following transverse osteotomy and following periosteal stripping, offering a uniquely well-controlled fluorescence dataset. An unsupervised classification machine leveraging 21 different spatiotemporal features was trained and evaluated by cross-validation in 3.5 million regions-of-interest obtained from 9 patients, demonstrating accurate stratification into normal, suspicious, and compromised regions. The machine learning (ML) approach also outperformed the standard method of using fluorescence intensity only to evaluate tissue perfusion by a two-fold increase in accuracy. The generalizability of the machine was evaluated in image series acquired in an additional three patients, confirming the stability of the model and ability to sort future patient image-sets into viability categories.

A displaced T type intercondylar distal humerus fracture with radial nerve palsy in a 10-year-old treated by closed reduction and K wire fixation

<p>T type intercondylar fractures of the distal hummers in the pediatric age group is an extremely rare injury. These fractures are difficult to diagnosed as they can be mistaken for extension type injuries. The few clinal trials on the management of the fracture, it is widely regarded that the accepted method of treatment is open reduction and rigid internal fixation. It is easier to ensure stable articular reconstruction of the intra articular fragments by this method. Open reduction and internal fixation of there fractures are associated with high complication rate, which include wound site problems, non-union due to periosteal stripping, heterotrophic ossification and iatrogenic nerve injury. Large soft tissue dissection can also lead to vascular compromise and significant scar tissue which is associated with a stiff elbow. We present a case of a 10-year-old boy who sustained an intercondylar fracture with radial nerve palsy which was treated by closed reduction and Kirshner wire fixation with excellent results at 1 year follow up.</p>

Prospective study on vacuum assisted closure therapy in treatment of soft tissue injuries associated with Gustilo Anderson compound grade III fractures

Introduction: The aim of this prospective study is to know the rate of wound infection, number of days required for making the wound fit for skin cover procedures, number of days required for formation of uniform granulation tissue bed in the wound, number of days of hospital stay and healing of soft tissue injury in Gustilo Anderson compound grade III fractures treated by Vacuum Assisted Closure & by stabilization of fracture. Gustilo Anderson compound grade III Fractures are fractures with extensive soft-tissue damage, definite periosteal stripping, massive contamination & the fractured ends are exposed.Methodology: In our institution thirty patients with Gustilo Anderson compound grade III patients were selected for this prospective study. The study period is from July 2020 to October 2021. All patients were selected based on our inclusion and exclusion criteria. Only Gustilo Anderson compound grade III fractures were included in the study.Results: After VAC therapy, SSG was done to cover the healthy granulation tissue in 22 patients and flap cover was done for 4 patients and remaining 4 was done by routine normal dressing.Conclusion: The time duration taken for formation of healthy granulation tissue was less.

Intramedullary headless compression screw fixation for midshaft fractures of the clavicle: A case report study

Historically, displaced midshaft clavicle fractures have been managed conservatively. However, recent literature has supported operative management of displaced and shortened clavicle fractures. Several options exist for surgical fixation, including plating and intramedullary (IM) fixation. IM fixation has the potential advantages of a smaller incision and decreased dissection and soft-tissue exposure and less prominent hardware.Rockwood and Hagie pins represented the most popular form of IM fixation during the last two decades,but concerns exist regarding stability and complications. The use of alternative IM implants, such as Kirschner wires, titanium elastic nails, and cannulated screws, also has been described in limited case series. However, concerns persist regarding the complications associated with the use of these implants, including implant failure, migration, skin complications, prominent screw head and construct stability. Our technique describes intramedullary fixation of midshaft clavicle fractures using a single headless compression screw (HCS) 4.5–6.5-mm. which is simple, affordable, and allows intramedullary compression, stability, load sharing, little periosteal stripping, very limited skin incision and rapid recovery after surgery.

Evaluation of functional outcome of distal tibial fractures managed with locking compression plate using minimally invasive plate osteosynthesis (MIPPO) technique

Background: Treatment of distal tibial fracture is challenging, because of precarious blood supply leading to poor healing. Various modality of surgical treatment such as closed intramedullary nailing, Open Reduction and internal fixation with conventional plate osteosynthesis and external fixation has been tried so far. But this modalities doesnot give better functional outcome and had high complication rate. The newer technique of distal tibia fractures fixation using MIPPO (minimally invasive percutaneous plate osteosynthesis), involves less soft tissue handling and minimal periosteal stripping resulting in low infection rate and faster healing. Aim of the Study: To evaluate clinical, functional and radiological outcomes after minimally invasive plate osteosynthesis using distal tibial locking compression plates. Materials and Methods: In this study, 30 patients with distal third tibial extra articular Metaphyseo diaphyseal fractures with or without associated fibula fractures were treated with MIPPO. The present prospective study was conducted in the department of Orthopaedics at Tripura Medical College, between August 2020 to July 2021. Results: All fractures had a good clinical and radiological union. The fractures were stabilized with MIPPO, at an average of 6.27 days post- trauma, with an average operative time of 66.25 minutes. Functional outcome evaluation was done using Olerud-Molander ankle score, at the end of 1 year. Average radiological union time of 17.6 weeks and there were one delayed union and one nonunion. None of the cases had implant failure or any significant deformity with good to excellent results in 86.66% cases. Conclusion: It is concluded that locking plate fixation by minimally invasive percutaneous plate osteosynthesis technique (MIPPO), is the most effective procedure for closed extra-atricular distal tibial Dia-metaphyseal fractures.

Pediatric versus adult magnetic resonance imaging patterns in acute high ankle sprains.

There is a paucity of literature describing MRI patterns of high ankle sprains in pediatric patients. Radiologists should understand MRI patterns of these injuries in both adults and children. To describe normal MRI appearance of pediatric syndesmotic ligaments and compare MRI patterns of high ankle sprains in children versus adults. We reviewed consecutive ankle MRIs performed over 3years and divided them into three cohorts: a normal pediatric (≤16years) cohort, and pediatric and adult cohorts with acute/subacute ankle syndesmosis injuries. Our retrospective review assessed interobserver agreement (Cohen kappa coefficient) and normal pediatric syndesmotic anatomy. We compared patterns of high ankle sprains (Fisher exact test) including ligament tears, periosteal stripping, avulsions and fractures. Of the 582 ankle MRIs, we included 25 in the normal pediatric cohort, 20 in the pediatric injury cohort and 23 in the adult injury cohort. The anterior and posterior tibiofibular ligaments all attached to cortex or cartilaginous precursor, while the interosseous ligament/membrane complex attached to the fibrous periosteum in 22/25 (88%) normal pediatric cases. Tibial periosteal stripping at the interosseous ligament/membrane complex attachment occurred in 7/20 (35%) pediatric and 1/23 (4%) adult injury cases (P=0.02). No other statistically significant differences were found. Interobserver agreement ranged from kappa=0.46 to kappa=0.82 (ligament tears), 0.38 to 0.45 (avulsions) and 0.69 to 0.77 (periosteal stripping). The normal interosseous ligament/membrane complex typically attaches to fibrous periosteum rather than bony cortex. Tibial periosteal stripping, usually without tibial fracture, is significantly more common among pediatric high ankle sprains. MRI patterns of high ankle sprains are otherwise not significantly different between children and adults.

Pre-auricular Transparotid Approach for the Management of Mandibular Condylar Fracture: An Experience of 82 Cases.

This paper retrospectively analyses the functional outcomes and complications associated with pre-auricular transparotid approach for the management of mandibular condylar fractures. The retrospective data of 82 condylar fractures were analysing in 73 patients who underwent open reduction and internal fixation with pre-auricular transparotid approach. Evaluation of post-operative complications and the post-operative occlusion status, maximal inter-incise opening, adequacy of reduction and stability of fixation were assessed clinically and radiographically. The exposure of fracture segment was adequate in all the cases, and fixation was easy with 2mm delta miniplate. Transient facial nerve palsy occurred in 2 patients (2.43%). 1 patient developed sialocele which was managed conservatively. There were slight occlusal discrepancies in 10 patients at the end of 1-week follow-up which was corrected with guiding elastics at the end of 1-month follow-up. The reduction was adequate, and fixation was stable. The functional outcomes were satisfactory in term of mouth-opening and range of motion. The pre-auricular transparotid approach provides direct access to the fracture site resulting in less retraction of the tissue containing facial nerve and also less amount of periosteal stripping is required, thus it maintains good vascularity to the fracture segments. It provides direct visualization of the fracture without much retraction of the tissue containing facial nerve branches. It allows better fixation of the fracture with very less complication which results in good functional outcomes.

A prospective study on functional outcome of distal tibial fracture fixation with locking compression plate using minimally invasive percutaneous osteosynthesis technique

Introduction: Treatment of distal tibia fractures is challenging because of its subcutaneous location, poor vascularity and limited soft tissue envelope. Various modalities of surgical treatment such as Intramedullary nailing, Open reduction and internal fixation with conventional plate osteosynthesis and external fixation have reported good functional outcome but had high complication rate. The newer technique of distal tibia fracture fixation with Minimally invasive plate osteosynthesis (MIPO) using Locking compressing Plates (LCP) has emerged as an alternative treatment option because it involves less soft tissue handling, minimal periosteal stripping resulting in low infection rate, faster healing and it respects biology of distal tibia and also provides biomechanically stable construct.Aim: To assess the functional role of locking compression plates in treatment of distal tibial fractures using minimally invasive percutaneous osteosynthesis technique.Materials and Methods: In this study, 30 patients with distal 1/3rd tibia extra articular fractures (AO type 43A1, 43A2, 43A3) with or without associated fibula fractures were treated with LCPs using MIPO technique. The present prospective study was conducted in Department of Orthopaedics, Geetanjali medical college and hospital, Udaipur between January 2019- May 2020.Results: All fractures had excellent clinical and functional outcome, the fractures were stabilized by LCP using MIPO technique with an average operative time of 48.16 minutes. The age of the patients ranged from 20 to 76 years with the fracture being most common in the 3rd and 4th decade. Out of 30 patients, 21 (70%) patients were males and 9 (30%) patients were females showing male preponderance. Functional outcome evaluation was done using American Orthopaedic Foot and Ankle Society (AOFAS) score. At the end of this study, 21 (70%) patients had excellent outcome, 08 (26.66%) had good results, 01 (3.33%) had fair outcome and no patient had poor functional outcome. None of the cases had implant failure or any significant deformity.Conclusion: The present study shows that MIPO technique using LCP proves to be most effective and safer technique in the management of distal tibial fractures with or without intra-articular comminution by providing good fracture healing, enabling rapid functional recovery and avoiding major complications.

Postradiation Fractures after Combined Modality Treatment in Extremity Soft Tissue Sarcomas.

Soft tissue sarcoma (STS) of the extremities is typically treated with limb-sparing surgery and radiation therapy; with this treatment approach, high local control rates can be achieved. However, postradiation bone fractures, fractures occurring in the prior radiation field with minimal or no trauma, are a serious late complication that occurs in 2–22% of patients who receive surgery and radiation for STS. Multiple risk factors for sustaining a postradiation fracture exist, including high radiation dose, female sex, periosteal stripping, older age, femur location, and chemotherapy administration. The treatment of these pathological fractures can be difficult, with complications including delayed union, nonunion, and infection posing particular challenges. Here, we review the mechanisms, risk factors, and treatment challenges associated with postradiation fractures in STS patients.

“A prospective study of minimally invasive percutaneous plate osteosynthesis using LCP for surgical management of distal tibia fracture”

Background: Management of distal tibia fracture is challenging because of wound infections and poor wound healing due to precarious blood supply. Various methods of surgical treatment had been tried, such as closed intramedullary nailing, open reduction and internal fixation with conventional plate osteosynthesis and external fixation however most of them have a high complication rate than a good functional outcome. The newer technique of distal tibia fractures fixation using MIPPO involves less soft tissue handling and minimal periosteal stripping resulting in a lower infection rate and faster healing. Materials and Methods: In this study, 25 patients with distal tibia extra articular fractures and intra articular fractures with or without associated fibula fractures were treated with MIPPO using medial LCP. The present study was conducted in the department of Orthopaedics at a tertiary care hospital and followed up for a period of 2 years. Results: The mean follow up period ranged from 6 weeks to 2 years. All the fractures were united at an average of 16 weeks and mean AOFAS score at the end of 1 year was 85.64. There were two superficial wound infections which were treated with oral antibiotics and there was one deep infection and another with persistent ankle pain. Conclusion: Minimally invasive percutaneous plate osteosynthesis is a reliable method of fixation not only extra articular, but also intra articular fractures of distal tibia. MIPPO technique for the distal tibia fractures offers a biological advantage by preserving the blood supply and decreases chances of delayed or non-union. Patients treated by MIPPO technique have a much lesser rate of deep infection and excellent radiological union. MIPPO technique helps in initiating early mobilization and reduces the risk of ankle stiffness.

Tension Band Wiring in Upper Extremity Surgery.

Tension band wiring is a simple, inexpensive, and effective technique to treat many upper extremity fractures. When tension forces result in a mechanical failure of bone, tension band wiring provides stability and promotes early mobilization by converting tensile forces across a fracture into compressive forces. The tension band principle has distinct advantages of reducing periosteal stripping, technical ease, and cost effectiveness when compared with other operative strategies. This technique can be implemented in a variety of fractures and avulsions about the upper extremity as well as small bone arthrodeses.

A short single-incision approach for antiglide plate fixation of oblique fractures of the lateral malleolus: a technical tip.

Displaced fractures (> 2mm) of the lateral malleolus, without medial or syndesmotic injuries, are often the subject of controversy regarding the best treatment option. In the past, these fractures were usually treated conservatively using a cast for 6 to 8weeks without weightbearing. Currently, most of the patients desire a quick return to their previous activities, what makes surgical treatment a reasonable choice. It has benefits as earlier ankle mobilization and weightbearing. It also restores ankle biomechanics, preventing secondary osteoarthritis. However, postoperative complications with the standard lateral incision exist such as implant discomfort, dehiscence and infection. Minimally invasive techniques have been described to help avoiding these complications. This technical note described a short single-incision approach for the surgical treatment of displaced oblique fibular fractures type AO/OTA 44-B1 with an antiglide plate that presents the advantage of less risk of damaging the soft tissues, periosteal stripping and disturbance of the fracture hematoma.

Femoral fracture in primary soft-tissue sarcoma of the thigh treated with radiation therapy: indications for prophylactic intramedullary nail.

Post-radiation fractures of the femur (PRF) are difficult to treat and are associated with a high risk of delayed union and non-union. We report a series of patients affected by soft tissue sarcoma (STS) of the thigh, treated with limb-sparing surgery and perioperative radiotherapy (RT), to analyse post-radiotherapy femur fracture (FF) rate and its management. 547 patients treated with surgery and RT for a deep primary STS of the thigh were included. "Periosteal stripping" and "bone tangential resection" were performed in case of tumor invasion. In the case of complete bone involvement, the patient received its complete resection and econstruction. Twenty-three (4.3%) patients underwent surgical procedures involving periosteum and cortical bone. In 11 (2.0%) patients a bone resection was required because of massive bone involvement. Six out of these 11 (54.5%) patients developed major complications (infection and aseptic loosening). At the time of STS excision, 11 patients (2.0%) underwent prophylactic intramedullary nailing (PIN). PRF occurred in 15 patients (3.0%) at a median follow up of 52months (range 3-151). Among patients who developed PRF, three were treated with a prosthesis (no complications) and eight nailing (7/8, 87.5% did not heal and developed a non-union). Given the potentially devastating complication of a PRF, PIN should be considered. We suggest prophylactic IM nail in patients at higher risk the time of STS excision. In other cases, IM nail can be postponed in the following years considering the prognosis.

Minimally invasive percutaneous plate osteosynthesis for closed proximal tibia fractures: A study of 30 cases

Tibial plateau fractures comprises about one percent of all fractures and complex bicondylar fractures comprise of 30% of all Tibial plateau fractures. Minimally invasive percutaneous plate osteosynthesis [MIPPO] is a method of biological fixation where a plate is percutaneously inserted and fixed at a distance proximally and distally from the site of fracture. By minimal exposure, this aids in the protection of the essential fracture hematoma, minimal soft tissue dissection, avoidance of periosteal stripping and providing a sufficient fixation. So the need for the study is to assess the effectiveness of the technique in achieving fracture union, functional outcome and to know the rate of complications associated with MIPPO. The purpose of this study was to assess the results and the efficacy of MIPPO for of the proximal tibia fracture. This is a prospective study of 30 patients with tibial condylar fractures treated by minimally invasive percutaneous plate osteosynthesis at Karpaga vinayaga institute of medical sciences and research center, Chengalpattu, Tamil Nadu. These patients were followed both clinically and radiologically after surgical fixation. A total of 30 patients with tibial condylar fracture were included in the study. The mean age of the participants was 38.70±14.14 years, with 21 (70%) males and 9 (30%) females. In our study containing 30 patients operated by MIPPO, we had 66.67% had excellent result, 20% had good results, 6.67% had fair results and remaining 6.67% had poor results. In our study it was found that high velocity injuries (type IV – VI) have poorer outcome than low velocity injuries (type I-III). In this way cautious patient selection, careful preoperative planning, delicate and reasonable soft tissue and bone handling, precise contouring of plates and vigorous postoperative rehabilitation and patient education appears to be the key to success of the procedure.

Ilizarov ring fixator for management of Schatzker type v and vi fractures of proximal tibia: A study of 30 cases

Introduction: Bicondylar tibia fractures are mostly treated by ORIF in a staged manner and involve lot of periosteal stripping and soft tissue disruption with potential complications of infection, hardware failures, compartment syndrome and delayed ambulation. Trans-osseous osteosynthesis using Ilizarov ring fixator seems to be a better emerging option for treating such fractures with minimal complications and better clinical and functional outcome. The aim of this study is to evaluate the role of Ilizarov ring fixator in Schatzker type V and VI fractures of proximal tibia. Methods: 30 patients with these injuries were included in the study after careful inclusion and exclusion criteria. All underwent standard Ilizarov ring fixation method with trans- fixation of knee in type VI fractures, which was removed at around 3 - 4 weeks and knee mobilization was started. Early weight bearing was encouraged in all cases except two with humerus fracture. Clinical followup was done at monthly intervals along with radiological evaluation. Pin site care was repeatedly stressed for and taught. Final follow up was done at six months post frame removal and Karlstrom-Olerud scoring system was used to analyze the final outcome. Results: There was no incidence of superficial or deep infection. All the fractures healed in time. Incidence of pin tract infection was 26.6% but it resolved with proper dressings and antibiotics. Average union time was around 17.46 weeks. There was no incidence of deep vein thrombosis or compartment syndrome or peroneal nerve injury. Overall result was Excellent in 12 cases, Good in 11 cases, Fair in 4 cases and Poor in 3 cases. Conclusion: Ilizarov fixator is a good, reliable and easily reproducible method of treating such fractures with early return to pre-injury levels in most of the cases.

Titanium Alloy Cutting Guides in Craniomaxillofacial Surgery—A Minimally Invasive Alternative to Synthetic Polymer Guides

Historically, synthetic polymers, such as polyamide, have been the predominate material used for patient-specific cutting guides in 3-dimensionally guided craniomaxillofacial surgery. The physical properties of polyamide result in guides that are bulky and difficult to place within the confines of the facial soft tissue envelope, requiring larger incisions with resultant morbidity. Despite their utility, we found the need for wider exposure simply for guide placement was unacceptable. The purpose of the present study was to evaluate our experience with the newly marketed titanium alloy cutting guides. We conducted a retrospective cohort study of patients who had undergone either segmental mandibulectomy or maxillectomy using patient-specific titanium alloy cutting guides from May to December 2019. The primary outcome variable was the need for an extended-access cervical incision or a transfacial incision for either maxillectomy or segmental mandibulectomy in patients with benign disorders. The secondary outcome variables included the need for a transfacial incision in patients with malignant pathology requiring either maxillectomy or composite oromandibular resection and the final histopathologic bone margin status. Of the 21 included patients, 11 had undergone maxillectomy (1 of 2) or segmental mandibulectomy (9 of 9) for benign disorders, with 91% (10 of 11) having undergone titanium alloy guide placement and resection entirely transorally without the need for an extended cervical or a transfacial incision. For 10 of the 11 patients undergoing immediate reconstruction with vascularized bone flaps, transcervical access was limited to small 1.5- to 2.5-cm incisions for target vessel access and microvascular anastomosis. None of the 10 patients with a malignant disorder requiring either maxillectomy or composite oromandibular resection required a transfacial incision. The bone margins, as determined by histopathologic analysis, were negative for 100% of the patients. Patient-specific titanium alloy cutting guides represent a viable alternative to traditional synthetic polymer guides. Their superior properties permit easier intraoral placement, decreasing the need for cutaneous incisions and excessive periosteal stripping.

Treatment of diaphyseal clavicular nonunion with special emphasis on microsurgery

Diaphyseal fractures of the clavicle had until recently the reputation to always heal with abundant callus formation, except if operated, due to a reported high rate of nonunion after plate fixation by older series. The reason would be that the bone has only periosteal vascularization, easily destroyed by periosteal stripping for implant apposition. Bone autograft and external fixation has been reported as the best technique to heal a nonunited clavicle nonunion. Are these classical considerations still valid nowadays? The purposes of this article focusing only on diaphyseal clavicular fractures are to review the vascularization of the bone, the rate of nonunion after nonoperative treatment, the indications and techniques of osteosynthesis, and the treatment possibilities of an established nonunion. This article will not deal with the specific problems of the lateral clavicular fractures, which are equivalent to acromio-clavicular fracture-dislocations, nor of medial fractures, close to the sterno-clavicular joint.

Functional outcome of distal tibial fractures treated by stainless steel locking plates with minimally invasive plate Osteosynthesis in rural population: A prospective study

Introduction: Open reduction and plating of distal tibial fractures require extensive soft tissue dissection and periosteal stripping. Complications like infection, delayed union and non-union are common. Minimally invasive plate Osteosynthesis (MIPO) technique preserves soft tissue envelope, vascularity of fracture fragments and containment of fracture haematoma and provide biologically favourable environment for fracture healing. Materials and methods: 20 patients of distal tibial fractures treated with locking plate by MIPO technique between October 2015 and January 2017 were included in this prospective study. Analysed using software SPSS version 24.0 Results: Mean average time to union is 15.2 weeks. Based on Tenny and Wiss scoring criteria, eighteen patients (90%) had good and excellent results at 22 weeks with fracture union.Conclusion: MIPO technique provides good healing and decreases the incidence of non-union and the need for bone grafting. This technique can be used in distal tibia fractures where nailing cannot be done, such as, fractures with small distal metaphyseal fragments, coronal fractures, Comminuted and intra-articular fractures.

Reconstruction of Bone Defect Combined with Massive Loss of Periosteum Using Injectable Human Mesenchymal Stem Cells in Biocompatible Ceramic Scaffolds in a Porcine Animal Model.

Clinically, in patients who sustain severe open fractures, there is not only a segmental bone defect needed to be reconstructed but also insufficient healing capacity due to concomitant damages to the periosteum and surrounding soft tissues. For studying the reconstruction of bone defects associated with massive loss of periosteum and surrounding soft tissues, there are no well-established preclinical models in large animals in the literature. The purpose of the study was to generate a large animal model of bone defect with massive periosteum loss and to adopt a tissue engineering approach to achieve rapid bony union with stem cells and biomaterials. In this study, a bone defect with massive periosteum stripping was generated in pigs, which was followed by emptying nearby canal marrow including fat and cancellous bone. The stripped periosteum was a mimic to the situation in the Gustilo type 3 open fractures. Bone defects were then reconstructed by impacting the biocompatible ceramic scaffold, morselized tricalcium phosphate (TCP) loaded with human adipose tissue-derived mesenchymal stem cells (hMSCs). Radiological and pathological assessments indicated that TCP and hMSCs synergistically promoted bone healing with increased lamination and ingrowth of vessels. Both bridging periosteum formation and gap filling were induced rapidly. In conclusion, a porcine model of segmental bone loss with damage of surrounding periosteum was created. Reconstruction of such defects with hMSCs and TCP achieved rapid union of bone defects associated with massive periosteal stripping.