Use Of Pedicled Graft Research Articles

The use of a dorsal capsular-based flap graft for scaphoid pseudarthrosis – long-term functional results

Introduction The scaphoid has a very tenuous blood supply that limits its capacity to recover from injury. A fracture of the scaphoid therefore presents an important risk of delayed union, pseudarthrosis and avascular necrosis. The fact that this type of fracture is many times missed on the first observation further increases the risk of pseudarthrosis. The use of pedicle grafts has the ability to fill the nonunion defect with new bone, bringing new osteoblasts and blood supply to the injury site. In 2006, Sotereanos described a capsular-based vascularized distal radius graft for the treatment of scaphoid pseudarthrosis that was readily available, close to the pseudarthrosis, required minimal rotation and did not need the dissection of a pedicle. The goal of our study was to evaluate the long-term results of the treatment of pseudarthrosis of the scaphoid using a capsular-based vascularized distal radius graft (as described by Sotereanos et al., 2006). Materials and methods Ten patients who underwent this procedure were identified, and the average follow-up time was 4,5 years (range 2–6 years). All but one patient were male, with an average age of 30 years (range 18–45). In 8 patients the non-dominant limb was the one affected. A dorsal approach was used, and the technique was according to Sotereanos et al., 2006. Results There were no postoperative complications such as infection or hardware migration. Of the 10 patients, 8 evolved to union, as determined by x ray and clinical examination. None of the patients was forced to abandon their professional activity after surgery, even though 25% required some type of adaptation necessary at their workplace. The average functional capacity was, according to the Mayo Wrist Score, of 82 points (range 65–90), corresponding to a “Good” function. The average disability according to the QuickDASH was 12.6 (range 0–45.5). The two patients with persistent symptomatic nonunions declined further surgical treatment and presented with the worst outcomes. All patients had decreased ROM after surgery. Discussion The union rate after surgery in this series is in line with previously published studies about this technique. No other published studies present long-term functional studies with this technique. Conclusion This technique is safe, easy and reliable for the treatment of scaphoid nonunions. Patients presented a good functional result at a mean follow-up of 4.5 years.

The use of the free vascularised bone graft for nonunion of the scaphoid: a systematic review

BackgroundFractures of the scaphoid are well known to be problematic especially when complicated by avascular necrosis, nonunion and carpal collapse. Fixation techniques have involved nonvascularised bone grafting; however, in the presence of avascular necrosis, generally poor union rates (47%) occur as identified by a meta-analysis performed by Merrell et al. The introduction of pedicled vascularised bone grafts showed further improvement; however, in the presence of carpal collapse, union rates as low as 50% have been reported by Chang et al. amongst others using the 1,2-intercompartmental supraretinacular artery pedicled graft. The difficulty lies in having a short pedicle with limited manoeuvrability to correct a humpback deformity and insert into the scaphoid cavity. Prior trauma to the soft tissues or distal radius may prohibit the use of pedicled grafts. The aim of this systematic review is to examine the published evidence for the use of free vascularised bone grafts in cases of scaphoid nonunion.MethodsA systematic review was performed with the following defined search strategy on MEDLINE and Google Scholar: ((scaphoid nonunion) OR scaphoid pseudarthrosis) AND bone graft. Articles were reviewed and data compiled into tables for analysis. Statistical analysis was performed with determination of descriptive statistics, and differences between the groups were calculated using categorical variables and chi-square test. A p value of 0.05 or less was considered to be statistically significant.ResultsTwo hundred and sixty-three articles were identified with a total of 12 articles meeting the inclusion criteria. Two hundred and forty-five cases of scaphoid nonunion were identified through the articles included in this systematic review. Fifty-six patients underwent free vascularised bone grafts from the medial femoral condyle with a 100% union rate and correction of humpback deformity, and 188 patients underwent free vascularised bone grafting from the iliac crest with an 87.7% union rate. The difference between the two similar groups was statistically significant (p = 0.006).ConclusionsThe promising data suggests that the medial femoral condylar free graft based on the descending genicular vessels can be considered in cases of proximal pole avascular necrosis and humpback deformity or in situations where other flaps are precluded or deemed unlikely to cause union.

Use of pedicled graft of buccal fat pad to line a nasal defect in releasing pushback palatoplasty

Use of pedicled graft of buccal fat pad to line a nasal defect in releasing pushback palatoplasty

The use of pedicle grafts in the repair of urinary tract fistulae

The use of pedicle grafts in the repair of urinary tract fistulae

The use of pedicle grafts in the repair of urinary tract fistulae : Richard Turner-Warwick, (44: 644, 1972)

The use of pedicle grafts in the repair of urinary tract fistulae : Richard Turner-Warwick, (44: 644, 1972)

The use of pedicle grafts in the repair of urinary tract fistulae.

British Journal of UrologyVolume 44, Issue 6 p. 644-656 THE USE OF PEDICLE GRAFTS IN THE REPAIR OF URINARY TRACT FISTULAE1 Richard Turner-Warwick B.Sc., D.M., M.Ch., F.R.C.S., M.R.C.P., F.A.C.S., Richard Turner-Warwick B.Sc., D.M., M.Ch., F.R.C.S., M.R.C.P., F.A.C.S. The Middlesex Hospital, St Peter's Hospital and Institute of UrologySearch for more papers by this author Richard Turner-Warwick B.Sc., D.M., M.Ch., F.R.C.S., M.R.C.P., F.A.C.S., Richard Turner-Warwick B.Sc., D.M., M.Ch., F.R.C.S., M.R.C.P., F.A.C.S. The Middlesex Hospital, St Peter's Hospital and Institute of UrologySearch for more papers by this author First published: December 1972 https://doi.org/10.1111/j.1464-410X.1972.tb10137.xCitations: 58 1 Read at the Twenty-eighth Annual Meeting of the British Association of Urological Surgeons in London, July 1972. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume44, Issue6December 1972Pages 644-656 RelatedInformation