Vascularized Bone Graft Research Articles

Reconstructive Allograft Preparation for Long Bone Intercalary Segments After Tumor Resections: Toronto Sarcoma Protocol.

Reconstructive Allograft Preparation for Long Bone Intercalary Segments After Tumor Resections: Toronto Sarcoma Protocol.

Superselective Catheter Angiographies of the Wrist (SCAW): Approaches for Vascularized Bone Grafts

Background: This study assesses the variability of the palmar radiocarpal artery (PRCA), dorsal carpal branch of the ulnar artery (DCBUA), and anterior interosseous artery (AIA) in superselective catheter angiographies of the wrist (SCAW). Methods: Secondary analysis of consecutive SCAW (2009-2011). Measurements of the distances of the PRCA to the midface of the radiocarpal joint, the DCBUA to the styloid process of the ulnar, and maximum diameters of PRCA, DCBUA, and AIA. Results: Seven female and ten male patients (mean 35 years) received SCAW. All patients suffered from Kienbock's disease. The mean distance from the PRCA to the radiocarpal joint was 7.9 ± 2.3 mm and the distance from the DCBUA to the styloid process of the ulna was 29.6 ± 13.6 mm. The mean maximum diameter of the PRCA was 0.6 ± 0.2 mm, that of the DCBUA was 1.1 ± 0.4 mm, and that of the AIA 1.2 ± 0.3 mm. In six cases (35%), all three arteries contributed to the PRCA; in eight cases (47%), the radial and AIA; in two cases (12%), the radial and ulnar artery; and in one case (6%), only the radial artery contributed. Conclusions: SCAW are feasible to assist in preoperative planning. Os pisiforme transfer with DCBUA might be the best choice for a vascular bone graft in Kienbock's disease.

Treatment of Refractory Congenital Pseudoarthrosis of Tibia with Contralateral Vascularized Fibular Bone Graft and Anatomic Distal Tibial Locking Plate: A Case Series and Literature Review

Congenital pseudoarthrosis of the tibia (CPT) remains a challenge for physicians. Several treatment options have been proposed, but the standard of care remains inconclusive. In this study, we present three patients for whom the failure of prior treatments was managed with a contralateral vascularized fibular bone graft (VFG) and an anatomic distal tibial locking plate. Between 2017 and 2021, three patients were referred for failed treatment of CPT. All patients had undergone multiple prior surgeries, including tumor excision and fixation with ring external fixators, plates, and screws. We performed radical tumor resection and reconstruction of bone defects with a VFG. The construct was fixed with an anatomic locking plate, and the patients were followed up for a mean of 45.7 months. All three patients were able to obtain graft union at 19.3 weeks. At the final follow-up, all grafts achieved bony hypertrophy without evidence of bone resorption or local tumor recurrence. There was a mean leg length difference of 8.5 cm preoperatively, compared with 6.3 cm postoperatively. The average lower leg angulation was 7.4 degrees and the average ankle range of motion was 58.3 degrees. The mean VAS score was 0 and the mean AOFAS score was 88.3. No significant complications were noted. Implantation of a VFG and an anatomic distal tibia locking plate can be considered an option for treatment-refractory CPT. Patients can expect to achieve bone consolidation, ambulate as tolerated, and have a low complication rate.

Patient Specific Alloplastic Implant Reconstruction of Mandibular Defects-Safe Practice Recommendations and Guidelines.

Mandibular continuity defects are commonly seen after tumor resection, osteomyelitis or maxillofacial trauma. Three-dimensional reconstruction of these mandibular segmental defects is critical for proper mandibular functioning and esthetics. Various methods used to reconstruct such defects include bridging reconstruction plates, modular endoprosthesis, non-vascularized and vascularized bone grafting with stock reconstruction plate or patient specific implants (PSI) and tissue engineering bone transfer. But in the recent years, literature documents use of PSI only alloplastic reconstruction as an alternate to microvascular bone flap reconstruction. Representative cases enumerate current practice of 'patient specific implant only' mandibular reconstruction and its pitfalls. This article discusses current status of literature on PSI's, choice of indications for 'PSI only' mandibular reconstruction and also proposes guidelines for safe practice of patient specific implant reconstruction of mandible.

Vascularized versus non-vascularized bone grafting for scaphoid nonunion without avascular necrosis: a randomized clinical trial.

In this clinical trial, patients were randomized to receive a pedicled vascularized bone graft, based on the 1,2-intercompartmental supraretinacular artery, or a non-vascularized iliac crest graft. Fixation was done with K-wires. Union and time to union were assessed using CT scans at regular intervals. Twenty-three patients received a vascularized graft, and 22 received a non-vascularized graft. Thirty-eight patients were available for union assessment and 23 for clinical measurements. There were no significant differences in union incidence, time to union, incidence of complications, patient-reported outcome scores, or wrist mobility and grip strength at final follow-up between the treatment groups. Smokers were 60% less likely to achieve union, independent of graft type. When controlling for smoking, patients receiving a vascularized graft were 72% more likely to achieve union. Given our small sample size, results should be interpreted with caution.Level of evidence: I.

Bone grafting for femoral head necrosis in the past decade: a systematic review and network meta-analysis.

Bone grafting is considered a method that can provide mechanical and structural support to the femoral head and prevent the collapse of the femoral head after core decompression (CD). However, there are no consensus guidelines on which bone grafting method is best after CD. The authors assessed the efficacy of various bone grafting modalities and CD through a Bayesian network meta-analysis (NMA). Ten articles were retrieved from PubMed, ScienceDirect, and Cochrane Library searches. Bone graft modalities are categorized into four, and CD is the control group: (1) CD, (2) autologous bone graft (ABG), (3) biomaterial bone graft (BBG), (4) bone graft combined with bone marrow graft (BG+BM), and (5) free vascular bone graft (FVBG). The rates of conversion to total hip arthroplasty (THA), femoral head necrosis progression rate, and Harris hip score (HHS) improvement were compared among the five treatments. A total of 816 hips were included in the NMA: specifically, 118 hips in CD, 334 in ABG, 133 in BBG, 113 in BG+BM, and 118 in FVBG. The NMA results show no significant differences in preventing conversion to THA and improving HHS in each group. All bone graft methods are better than CD in preventing osteonecrosis of the femoral head (ONFH) progress [ABG: odds ratio (OR)=0.21, 95% CI: 0.07-0.56; BBG: OR=0.13, 95% CI: 0.03-0.52; BG+BM: OR=0.06, 95% CI: 0.01-0.24; FVBG: OR=0.11, 95% CI: 0.02-0.38]. The rankgrams indicate that BG+BM is the best intervention in preventing conversion to THA (73%), preventing ONFH progress (75%), and improving HHS (57%), followed by the BBG in preventing conversion to THA (54%), improving HHS (38%), and the FVBG in preventing ONFH progress (42%). This finding indicates that bone grafting after CD is necessary to prevent ONFH progression. Moreover, bone grafts combined with bone marrow grafts and BBG seem to be effective treatment methods in ONFH.

First Dorsal Metacarpal Artery-pedicled Second Metacarpal Vascularized Bone Graft for Nonunion after Thumb Carpometacarpal Arthrodesis

Arthrodesis is a reliable surgical procedure for treating thumb carpometacarpal osteoarthritis. However, the most frequent and problematic complication of arthrodesis is nonunion. Although postarthrodesis-related nonunion is a common complication, the indications and results of revision procedures for this pathological condition have not been well documented. A 59-year-old man underwent arthrodesis for thumb carpometacarpal osteoarthritis, which resulted in painful nonunion 7 months after the surgery. We performed revision surgery for this pathological condition, using first dorsal metacarpal artery-pedicled second metacarpal vascularized bone graft. This method resulted in successful bone union and pain relief. First dorsal metacarpal artery-pedicled second metacarpal vascularized bone grafting could be an alternative method for nonunion, which is a common complication after thumb carpometacarpal arthrodesis.

Bone Morphology and Vascular Supply of Pedicled Distal Radius Bone Using Nano-Computed Tomography.

The goal of this study was to use nano-computed tomography to describe the intraosseous vascularity and structural characteristics of commonly used distal radius vascularized bone grafts for treatment of scaphoid nonunion. We obtained 8 fresh frozen human cadaver forearm specimens for infusion of barium contrast. Specimens were scanned and segmented to quantify the vascular volume and trabecular density within 3 common graft regions, including 1, 2 intercompartmental supraretinacular artery (1,2 ICSRA), fourth extensor compartment artery (4 ECA), and volar carpal artery (VCA), as well as thirds of the scaphoid. Outcomes also included mean and maximum cortical thickness and number of cortical perforators. Single-specimen analyses were also performed comparing vascularity and trabecular density of each graft with scaphoid regions of a single specimen. Statistical analysis was performed using analysis of variance with post hoc Tukey testing when P value was less than .05. There was no significant difference between groups in the mean percent vascularity (P = .76). The ratio of trabecular bone in each graft to scaphoid thirds was less than 1. The mean cortical thickness (0.79 mm, 95% confidence interval [CI], 0.66-0.93 mm) and maximum cortical thickness (1.45 mm, 95% CI, 1.27-1.63 mm) of VCA grafts were both significantly greater than those of 4 ECA and 1,2 ICSRA (P < .001). There were no differences between vascular density of the 3 grafts and the scaphoid. Pedicled distal radius bone grafts have similar vascularity but morphometric differences such as cortical thickness and trabecular density which have unclear clinical implications.

Vascularized Bone Flaps for Salvage Ankle Fusion

Objective: The ankle is a critical load-bearing joint for the lower extremity that is prone to damage from a variety of causes. Achieving stable bony fixation is paramount to restoring function after ankle injury. Initial attempts at fixation with hardware may fail, or large bone deficits may make primary fixation impossible. Vascularized bone grafts can be used to create stable and functional reconstruction of the ankle. Methods: We reviewed our experience using vascularized bone flaps to achieve bony ankle fusion in patients with unstable ankle joints. We then developed indications for whether the use of pedicled flaps versus free tissue transfer will best accomplish successful fusion. Results: At our institution, a single surgeon has performed 6 cases of vascularized bone grafts for ankle fusion. Three of these were pedicled fibula flaps and three were free fibula flaps. One of the free fibula flaps had persistent non-union and was salvaged with a medial femoral condyle free flap to achieve bony fusion. All patients had improved pain and were able to bear weight on the ankle joint post-operatively. Pedicled fibula flaps can be used when there is avascular necrosis of the talus or distal tibia, non-union after ankle fusion, failed total ankle replacement, or for large bony defects. Free fibula flaps are required when there is non-union of the distal fibula, if there is need for tibiotalocalcaneal fusion, and therefore need to extend the fibula to the calcaneus, or if the lateral malleolus has been already taken down during prior ankle fusion. Conclusion: Ankle reconstruction presents a challenging problem, but vascularized bone grafts can provide stable and functional results for patients. Using the indications we have developed for the use of pedicled flaps versus free tissue transfers can help other surgeons tackle these difficult cases. Corresponding Author: Gretchen Stieg MD, Department of Plastic & Reconstructive Surgery Detroit Medical Center/Wayne State University, 4160 John R, Suite 400, Detroit, MI 48201, Email: [email protected], Phone: (407) 252-0909

Decellularized vascularized bone grafts: A preliminary in vitro porcine model for bioengineered transplantable bone shafts.

Introduction: Durable reconstruction of critical size bone defects is still a surgical challenge despite the availability of numerous autologous and substitute bone options. In this paper, we have investigated the possibility of creating a living bone allograft, using the perfusion/decellularization/recellularization (PDR) technique, which was applied to an original model of vascularized porcine bone graft. Materials and Methods: 11 porcine bone forelimbs, including radius and ulna, were harvested along with their vasculature including the interosseous artery and then decellularized using a sequential detergent perfusion protocol. Cellular clearance, vasculature, extracellular matrix (ECM), and preservation of biomechanical properties were evaluated. The cytocompatibility and in vitro osteoinductive potential of acellular extracellular matrix were studied by static seeding of NIH-3T3 cells and porcine adipose mesenchymal stem cells (pAMSC), respectively. Results: The vascularized bone grafts were successfully decellularized, with an excellent preservation of the 3D morphology and ECM microarchitecture. Measurements of DNA and ECM components revealed complete cellular clearance and preservation of ECM's major proteins. Bone mineral density (BMD) acquisitions revealed a slight, yet non-significant, decrease after decellularization, while biomechanical testing was unmodified. Cone beam computed tomography (CBCT) acquisitions after vascular injection of barium sulphate confirmed the preservation of the vascular network throughout the whole graft. The non-toxicity of the scaffold was proven by the very low amount of residual sodium dodecyl sulfate (SDS) in the ECM and confirmed by the high live/dead ratio of fibroblasts seeded on periosteum and bone ECM-grafts after 3, 7, and 16days of culture. Moreover, cell proliferation tests showed a significant multiplication of seeded cell populations at the same endpoints. Lastly, the differentiation study using pAMSC confirmed the ECM graft's potential to promote osteogenic differentiation. An osteoid-like deposition occurred when pAMSC were cultured on bone ECM in both proliferative and osteogenic differentiation media. Conclusion: Fully decellularized bone grafts can be obtained by perfusion decellularization, thereby preserving ECM architecture and their vascular network, while promoting cell growth and differentiation. These vascularized decellularized bone shaft allografts thus present a true potential for future in vivo reimplantation. Therefore, they may offer new perspectives for repairing large bone defects and for bone tissue engineering.

Osseointegration and Bone Resorption of Scapula Tip Free Flaps in Mandibular Reconstruction.

Bone resorption of more conventional vascularized bone grafts have been well described showing minimal resorption over time. Few studies have evaluated osseous union and bone resorption in scapula tip free flaps (STFF) in the reconstruction of mandibulectomy defects. We aimed to describe our series on STFF with respect to osseous union and bone resorption over time. Retrospective chart review of patients receiving STFF from January 2014-January 2017 (n=25). A neuroradiologist analyzed follow-up CT scans to assess (1) STFF complete, partial, or no osseous union with native mandible and (2) STFF volume change over time in a subset with multiple follow-up scans (n=18). Twenty-three of 25 patients (92%) showed complete or partial STFF osseous union with native mandible either distally or proximally. STFF volume change ranged from +4.8 to -54% (median -0.5%) over median follow-up interval of 23 months. History of chemoradiation therapy, bisphophonate use, sex, age, or smoking history did not correlate with bone resorption. STFFs shows high rates of osseous union and limited bone resorption that is equivalent to, or less than, vascularized fibular and iliac crest flaps. Clinically, this translates into both optimal healing andfunctional and cosmetic outcomes, especiallyin the setting of prior therapies. 4 Laryngoscope, 133:2597-2602, 2023.

A CASE REPORT ON TREATMENT OF KIENBOCK'S DISEASE BY IMPLANTATION OF VASCULAR PEDICLE AND BONE GRAFTING

Numerous literatures have described various procedures in the treatment of Kienbock's disease depending upon the severity of the symptoms, patient characteristics and radiological staging. These range from conservative management to surgical procedures. The case under study had Lichtman stage ** disease. Vascularised bone grafts provide improved blood flow, osteocyte preservation, and accelerated healing rates. We inserted pronator quadratus pedicled bone graft into our case of lunate osteonecrosis and temporarily fixed the graft. Clinically, the patient reported pain subsidence with improvement in range of motion and grip strength. Vascularised pedicle and bone grafting is an effective way for treatment of early and middle stages of osteonecrosis of lunate

Decellularized vascularized bone grafts as therapeutic solution for bone reconstruction: A mechanical evaluation.

Large bone defects are challenging for surgeons. Available reimplanted bone substitutes can't properly restore optimal function along and long term osteointegration of the bone graft. Bone substitute based on the perfusion-decellularization technique seem to be interesting in order to overcome these limitations. We present here an evaluation of the biomechanics of the bones thus obtained. Two decellularization protocols were chosen for this study. One using Sodium Dodecyl Sulfate (SDS) (D1) and one using NaOH and H2O2 (D2). The decellularization was performed on porcine forearms. We then carried out compression, three-point bending, indentation and screw pull-out tests on each sample. Once these tests were completed, we compared the results obtained between the different decellularization protocols and with samples left native. The difference in the means was similar between the tests performed on bones decellularized with the SDS protocol and native bones for pull-out test: +1.4% (CI95% [-10.5%- 12.4%]) of mean differences when comparing Native vs D1, compression -14.9% (CI95% [-42.7%- 12.5%]), 3-point bending -5.7% (CI95% [-22.5%- 11.1%]) and indentation -10.8% (CI95% [-19.5%- 4.6%]). Bones decellularized with the NaOH protocol showed different results from those obtained with the SDS protocol or native bones during the pull-out screw +40.7% (CI95% [24.3%- 57%]) for Native vs D2 protocol and 3-point bending tests +39.2% (CI95% [13.7%- 64.6%]) for Native vs D2 protocol. The other tests, compression and indentation, gave similar results for all our samples. Vascularized decellularized grafts seem to be an interesting means for bone reconstruction. Our study shows that the decellularization method affects the mechanical results of our specimens. Some methods seem to limit these alterations and could be used in the future for bone decellularization.

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.

Treatment of failed scaphoid nonunion fixation using free medial femoral condyle vascularized bone grafting.

Nonunion in scaphoid fractures may be considered a devastating problem. Union failure results in scaphoid deformity, resorption, and bone loss. Failed previous fixation decreases remaining bone stock and makes it more difficult to achieve union. Free vascularized graft represents a good option to achieve scaphoid union with revision fixation. Our study aims at the assessment of the management of scaphoid fractures non-union after failed previous fixation with the use of a free vascularized graft from the medial femoral condyle. This is a retrospective study including 16 cases with persistent scaphoid nonunion after previous fixation managed by vascularized medial femoral condyle grafts. The mean follow-up was 24 months. Previous surgical attempts and nonunion duration were noted. We evaluated the union rate, together with ROM, Scapholunate angles and pain scores. the union was achieved in 13 of 16 cases. Pain improved in all patients (10/16 complete relief). Wrist ROM at follow-up was an average of 50° flexion 48° extension. There was no change in the relationship between lunate and scaphoid with an average angle of 37.5° preoperative and 38° postoperative. Free vascularized MFC grafts are considered a reliable method to treat persistent nonunion of scaphoid fractures after failed previous operations. Short-term follow-up data showed considerable union rates with adequate pain relief and satisfactory ROM.

KIENBÖCK'S DISEASE, AVASCULAR NECROSIS OF THE LUNATE

Introduction: Avascular necrosis of the lunate bone was described in 1910 by the Austrian radiologist Robert Kienböck, which is named after him. A mixture of different factors such as mechanical, vascular and genetic predisposition may be related to the pathogenesis of this disease. As for the natural evolution of the disease, failure in early diagnosis and early treatment may lead to a gradual evolution from stage I to stage IV, causing discomfort to the patient. Objective: to detail the current information related to avascular necrosis of the lunate, description, etiology, classification, imaging presentation and management of Kienböck's disease. Methodology: a total of 32 articles were analyzed in this review, including review and original articles, as well as clinical cases, 20 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: Kienböck, avascular necrosis of the lunate and lunatomalacia. Results: it is the second most frequent cause of avascular necrosis of the carpal bones and generally affects males between 20 and 40 years of age. Nuclear magnetic resonance has a greater contribution due to greater sensitivity and detection of radiographically occult cases, computed tomography also has a good specificity at the time of diagnosis. Radiography at the beginning of the disease does not present evident changes and nuclear scintigraphy presents non-specific findings. In the first stage, the treatment is based on immobilization with a plaster cast or splints. When incomplete necrosis is evidenced in the second stage, conservative treatment can be performed, however with complete necrosis or in the third and fourth stage, it requires "joint leveling" surgery and probably vascular bone grafting or transfer of branches of adjacent arteries. Stage IIIA usually merits lunate restoration, in stage IIIB and Lichtman IV wrist arthrodesis can be used. Conclusions: Kienböck's disease presents with unilateral pain over the dorsal aspect of the wrist, weakness and limited wrist motion, in addition to functional impotence, decreased grip strength, wrist edema, sensory disturbances in the median nerve territory and synovitis, depending on the stage. It is related to the following variables such as ulnar minus or ulnar negative variation, vascular contribution of the lunate bone, morphology of the lunate, radial inclination angle. The diagnosis is clinical and imaging where Lichtman's classification is useful. Treatment will depend on the cause and also on the stage of the disease.

An Analysis of the Viability of Nonvascular Iliac and Fibula Grafts in Mandibular Reconstruction in Patients with Circulatory Diseases: A Prospective Randomized Study.

Vascularized bone grafts are considered as the gold standard for mandibular reconstruction. However, there are certain limitations of them, such as they are contraindicated in patients with circulatory disturbances. Therefore, Non-vascular bone grafts become the viable option for reconstruction. Our study aims to prospectively compare the long-term viability of avascular iliac and fibula bone grafts in the reconstruction of mandibular defects. Objectives were to evaluate the difficulty in swallowing, mastication, speech problems, infection, wound dehiscence, restricted limb movement, and altered gait among the iliac and fibula group. A total of 14 patients, planned for the reconstruction of mandibular defects from 2016 to 2018 were randomly allocated into two groups; nonvascular iliac and fibula graft groups. Clinical assessment for improvement in function, esthetics, wound healing, pain, and donor site morbidity was done and was followed up for one year. Digital orthopantomogram was taken for radiographic evaluation for up to one year. Difficulty in swallowing, mastication, speech, infection, restricted limb movement, and altered gait was statistically significant and was seen more in the fibula group. Wound dehiscence with graft exposure was found in one subject. The overall success rate was 100% in the iliac group and 85.7% in the fibula group. Considering the long-term complications and success rate, the nonvascular iliac graft was found to be superior and can be used as an alternative to a nonvascular fibula graft for a defect length up to 7cm.

Comparative Study Between Closed Reduction Internal Fixation Alone Versus Closed Reduction Internal Fixation and Addition of Muscle Pedicle Bone Graft for Prevention of Osteonecrosis in Cases of Displaced Femoral Neck Fractures.

In patients of less than 60years of age, osteosynthesis is the treatment of choice for displaced femoral neck fractures (Garden 3 and 4). Most of these fractures unite well but chances of osteonecrosis are quite high even after early operations and till date there is no well-defined method of prediction and prevention of osteonecrosis. Vascularized bone graft may prevent the development of osteonecrosis. This is a retrospective case control study done in an urban Medical College in eastern India and tried to evaluate efficacy of addition of quadratus femoris muscle pedicle bone graft in cases of osteosynthesis comparing the results of cases treated with closed reduction and internal fixation alone for femoral neck fractures We have taken into consideration 45 consecutive cases from each group with identical demographic background and of very similar age pattern of 20years to 60years.For further reference, we will describe Group I for closed reduction and CHS/DHS only, and Group II for closed reduction CHS and quadratus femoris muscle pedicle graft. Satisfactory bony union occurred in 42 out of 45 follow-up patients in Group 1 (93.3%) and 43 out of 45 patients in Group 2. (95.5%) In 2- to 10-year follow-up period, eight patients (18.6%) developed osteonecrosis in Group I, and in Group 2, in the same period, there were no cases of osteonecrosis. Addition of quadratus femoris muscle pedicle bone graft is a very effective procedure for prevention of osteonecrosis when we attempt osteosynthesis by closed reduction and internal fixation for displaced femoral neck fractures.

Comparison of the clinical outcomes between vascularized bone graft and the Masquelet technique for the reconstruction of Gustilo type III open tibial fractures

BackgroundGustilo type III tibial fractures commonly involve extensive soft tissue and bony defects, requiring complex reconstructive operations. Although several methods have been proposed, no research has elucidated the efficacies and differences between vascular bone graft (VBG) and the Masquelet technique (MT) to date. We aimed to evaluate and compare the clinical effectiveness of VBG and the MT for the reconstruction of Gustilo type III tibial fractures.MethodsThis retrospective cohort study enrolled patients who underwent reconstruction for Gustilo type III tibial fractures using VBG or the MT in a single center from January 2000 to December 2020. The patients’ demographics, injury characteristics, and surgical interventions were documented for analysis. The clinical outcomes including union status, time to union, postoperative infections, and the causes of union failure were compared between the two groups.ResultsWe enrolled 44 patients: 27 patients underwent VBG, and 17 underwent MT. The average union time was 20.5 ± 15.4 and 15.1 ± 9.0 months in the VBG and MT groups, respectively (p = 0.232). The postoperative deep infection rates were 70.4% and 47.1% in the VBG and MT groups (p = 0.122), respectively. Though not statistically significant, the VBG group had a shorter union time than did the MT group when the bone defect length was > 60 mm (21.0 ± 17.0 versus 23.8 ± 9.4 months, p = 0.729), while the MT group had a shorter union time than did the VBG group when the bone defect was length < 60 mm (17.2 ± 5.6 versus 10.7 ± 4.7 months, p = 0.067).ConclusionsVBG and MT are both promising reconstruction methods for Gustilo type III tibial fractures. VBG appears to have more potential in reconstructing larger bone defects, while MT may play an important role in smaller bone defects, severe surgical site infections, and osteomyelitis. Therefore, flexible treatment strategies are required for good outcomes in Gustilo type III open tibial fractures.

Vascular Supply of the Wrist.

The vascular anatomy of the wrist is vital in the development of multiple disorders at the carpus. Understanding this vascular network may prevent iatrogenic injury to the blood supply and can be used by surgeons through vascularized bone grafts. Multiple surgical techniques take advantage of the vascular network. This article reviews the blood supply of the distal radius, ulna, and carpal bones and its clinical implications.