Vascularized Iliac Bone Graft Research Articles

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

Osteonecrosis of the hip: is there a difference in the survivorship of total hip arthroplasty with or without previous vascular iliac bone grafting?

BackgroundOsteonecrosis of the femoral head (ONFH) is a debilitating condition. Vascularized iliac bone graft (VIBG) is a joint-preserving surgery to improve blood supply to the avascular portion of the femoral head which may delay secondary osteoarthritis and total hip arthroplasty (THA). However, whether VIBG will affect the subsequent THA survivorship and outcomes are still uncertain.MethodsImplant survivorship and clinical outcomes were compared between 27 patients who had undergone prior VIBG and 242 patients who had only undergone THA for ONFH. Baseline characteristics and the postoperative Harris Hip Score (HHS) were also recorded and compared between the two groups. Implant survivorship was determined using Kaplan-Meier survival analysis.ResultsThe overall implant survival for all patients who had a primary diagnosis of ONFH and eventually underwent THA was 92.9%. There was no significant difference in the implant survivorship between the group who directly received THA (survivorship of 93%) and the group which failed VIBG and was subsequently converted to THA (survivorship of 91.9%) (p = 0.71). In addition, higher THA revision rates were associated with smokers and drinkers.ConclusionsVIBG may be a reasonable option as a “buy-time” procedure for ONFH. Even if conversion to THA is eventually required, patients may be reassured that the overall survivorship and clinical outcomes may not be compromised. Patients are recommended to give up smoking and binge drinking prior to THA to increase implant survival rate.

Long-term outcome of vascularized iliac bone grafting for osteonecrosis of femoral head: A retrospective study with 17-year follow-up.

This study aims to investigate the long-term results of vascularized iliac bone grafting (VIBG) for osteonecrosis of the femoral head (ONFH). The primary outcome is the long-term survivorship of VIBG, using conversion to total hip arthroplasty as an end-point. Secondly, this study will also analyse the patient or disease factors influencing the long-term survivorship of VIBG. Forty-two patients (50 hips) underwent VIBG for ONFH in our institute between September 1995 and November 2013. Only patients with a follow-up of at least 5 years were included. The risk factors, surgical complications and VIBG survivorship were recorded. The stage of ONFH was classified according to the Ficat staging of the pre-operative radiographs. VIBG was only performed to patients with ONFH of Ficat stage II and stage III. Patients with hip arthritis (Ficat stage IV) did not receive VIBG and thus excluded from the study. Long-term survivorship of VIBG is measured by conversion to total hip arthroplasty. Twenty-eight hips (56%) had surviving VIBG for the duration of follow-up. The overall mean graft survival was 12.2 ± 7.8 years (0.4-24.0). Steroid and alcohol-induced osteonecrosis were more predominant in the graft-failure group, which had a hazard ratio of 2.33 and 2.07 respectively for graft failure (p = 0.047). In terms of complication, there was one case of groin wound infection which required surgical debridement. At a long-term follow-up of 17 years, our results showed that VIBG is effective in treating patients with pre-collapse (Ficat Stage II) and early post-collapse (Ficat stage III) in ONFH. Alcoholics and patients with steroid are at a higher risk of graft failure, so VIBG should be performed cautiously in these patients. VIBG is an intermediate operation until osteoarthritis sets in, either by the progression of ONFH or natural degenerative change.

Gefäßgestieltes Beckenkammtransplantat zur Behandlung der Femurkopfnekrose

Illustration of anowadays only rarely performed operative procedure for the treatment of osteonecrosis of the femoral head to prevent or at least delay advanced arthrosis and the need for atotal hip replacement. The pedicled vascularized iliac bone graft is raised without the need for special microsurgical techniques and has less vascular complications often seen in free vascularized grafts. Early stages of osteonecrosis of the femoral head stagesII andIII according to the Association Research Circulation Osseous (ARCO) up to the detection of fracture lines (crescent sign) but without mechanical insufficiency. Osteonecrosis of the femoral head with collapse of the femoral head (ARCO stage ≥IIIB) and mechanical insufficiency. Patients who are noncompliant or anot able to take the weight off the operated leg. Patients who had radiotherapy or an operation on ipsilateral inguinal lymph nodes and patients who have vascular anomalies or severe arteriosclerosis. Debridement of the femoral head osteonecrosis and implantation of apedicled vascularized iliac bone graft. Free movement of the hip joint 4weeks after surgery. Outward rotation of the hip joint allowed after 3months and restriction of weight load on the operated leg for at least 3-6months postoperatively depending on the bony consolidation. Vascularized bone grafts for the treatment of femoral head necrosis show better clinical and radiological results than avascular bone grafts. Nevertheless, after 5years follow-up approximately 25% of the operated hips formerly in stageII show further progression of radiological necrosis. In stageIII all hips eventually show progress of femoral head collapse and the need of atotal hip replacement. Concerning the outcome of afree vascularized bone graft (fibula flap) compared to the pedicled vascularized graft from the iliac crest for treatment, the anatomically demanding area and ahigher complication rate should be considered even though the cancellous bone of the iliac crest is biologically ideal. Nowadays afree vascularized fibular graft is the most frequently used bone graft for treatment of femoral head necrosis.

Retrospective Long-Term Follow-Up Survival Analysis of the Management of Osteonecrosis of the Femoral Head With Pedicled Vascularized Iliac Bone Graft Transfer

BackgroundOsteonecrosis of the femoral head (ONFH) often affects young, active adults and leads to the destruction of the hip joint and disabling arthritis. Several procedures have been developed to prevent conversion to total hip arthroplasty (THA), especially in young patients who have a high rate of hip revision surgery. The aim of this long-term follow-up is to analyze the results of vascularized iliac bone flap transfer for ONFH treatment. MethodsWe retrospectively reviewed 856 patients (1006 hips) who accepted hip-preserving surgery with vascularized iliac bone grafting due to ONFH (Ficat and Arlet stages II-IV) from January 1985 to December 2012 at our hospital. Radiographic assessment was performed with the Ficat and Arlet system, clinical assessment was performed with the Harris Hip Score system, and quality of life was evaluated with the 36-Item Short Form Survey. The hips included 575 stage II hips, 382 stage III hips, and 49 stage IV hips. We defined clinical failure as conversion to THA or any other hip-preserving surgery because of hip symptoms. ResultsA total of 856 patients (1006 hips) were eventually followed up with an average time of 15 years (range 5-25). In total, 75 patients were lost to follow-up, and 105 hips were converted to THA. The average Harris Hip Score was 87.43 ± 6.42 points at the last follow-up, representing a great improvement compared to the 66.42 ± 6.52 points obtained preoperatively. The Kaplan-Meier survival analysis showed no difference in the 15-year survival rate between patients with stages II and III disease (using THA as an end point). However, the survival rate was lower for patients with stage IV disease than that for patients with stages II and III disease. The survival rate for patients in the glucocorticoid group was lower than that for patients in the idiopathic, alcoholic, and trauma groups. The Physical Component Summary scores ranged from 78 ± 10 to 85 ± 14 postoperatively compared to 30 ± 14 to 55 ± 15 preoperatively, and the postoperative Mental Component Summary scores (range from 34 ± 11 to 59 ± 12) were significantly higher than the preoperative scores (range from 72 ± 11 to 90 ± 10), representing great improvement in patient quality of life. Postoperative complications occurred in 86 patients (4.5%) during the follow-up, including 23 patients with deep venous thrombosis, 16 patients with meralgia paresthetica (which resolved), and 47 patients with secondary wound healing. ConclusionThe vascularized iliac bone flap grafting technique yields significant improvement (particularly in the precollapse disease stages in young patients) for restoration of the biomechanical support of the collapsed femoral head and reconstruction of the blood supply to the osteonecrotic area. This procedure allows these patients to avoid or delay the need for THA surgery.

Reconstruction of Mandible: A Fully Digital Workflow From Visualized Iliac Bone Grafting to Implant Restoration

Although digital aids can help surgeons compensate for the shortcomings of traditional mandibular reconstruction techniques to perform surgery more precisely and effectively, the use of these digital techniques has often been fragmented, divided, and incomplete. This article describes the workflow of a fully digital mandibular reconstruction to explore the proper indications and discusses innovations based on the accuracy and effectiveness of digital techniques. A restoration-oriented mandibular reconstruction was performed by applying different digital techniques. Preoperative virtual surgery and rapid prototyping were used to aid the vascularized iliac bone graft surgery, which offered a solid basis for the ensuing treatment. Subsequently, implant rehabilitation was accomplished with the assistance of computer-assisted design and manufacture, laser treatment, and selective laser melting techniques. The workflow of the fully digital mandibular reconstruction successfully achieved a restoration-oriented treatment. These predictable, accurate, and effective digital techniques improved the consistency of pretreatment design and follow-up treatment. The treatment sequence achieved high predictability and reproducibility owing to the use of digital techniques. This study shows that a digital workflow can be predictable, accurate, and effective, which suggests that it could be a valid digital protocol for developing a treatment sequence for patients with jaw defects caused by trauma, congenital anomalies, or mandibular tumor resection.

Total wrist arthrodesis for septic wrist arthritis and loss of the bony carpus following percutaneous pinning of the fifth carpometacarpal joint: a case report

We report on a patient who developed septic wrist arthritis with destruction of the entire carpus due to osteomyelitis following percutaneous pinning of a fifth metacarpal base fracture. Arthrodesis was performed using a 6 cm vascularized iliac bone graft. This case report may sharpen the surgeon’s awareness of risks in orthopedic surgeries, even though the procedure seems to be rather simple and the patient is young and seems to be healthy.

Vascular pedicled iliac bone grafting is effective in patients with an early stage of femoral head avascular necrosis

This study aims to evaluate clinical and radiological findings of a series of patients with avascular necrosis of the femur head (ANFH) treated by core decompression and vascular pedicled iliac crest grafting. This retrospective study included 26 hips of 22 patients (14 males, 8 females; mean age 36 years; range 16 to 48 years) with ANFH using the vascularized iliac bone grafting between March 2003 and July 2010 in our clinic. The main predisposing factor was steroid use in 13 patients. All patients were assessed clinically according to the Harris hip score and by radiographs by the Association Internationale de Recherche sur la Circulation Osseuse (ARCO) staging system. The mean follow-up was 36 (range 14 to 62) months. Eleven hips (42%) had stage II and 15 hips (58%) had stage III ANFH. The mean Harris scores increased from 52 (range 31 to 63) to 82.8 (range 62 to 90) after surgery. Based on clinical outcomes, 18 hips (69%) were presented as excellent and good, while eight hips presented fair and poor. According to the ARCO staging system, satisfactory results were provided in 17 (65%) of the 26 hips. Two of four hips at preoperatively stage II progressed to stage III, two other hips to stage IV. Five hips at stage III preoperatively progressed to stage IV and these hips had to undergo hip replacement. Our results suggest that core decompression and the vascular pedicled iliac bone grafting are effective in early stages of ANFH.

Vascularized Iliac Bone Graft with Rotational Osteotomy of the Femoral Head for Extensively Large Collapsed Lesions of Necrosis of the Femoral Head

Vascularized Iliac Bone Graft with Rotational Osteotomy of the Femoral Head for Extensively Large Collapsed Lesions of Necrosis of the Femoral Head

Vascularized Iliac Bone Graft with Rotational Osteotomy of the Femoral Head for Extensively Large Collapsed Lesions of Necrosis of the Femoral Head

Vascularized Iliac Bone Graft with Rotational Osteotomy of the Femoral Head for Extensively Large Collapsed Lesions of Necrosis of the Femoral Head

Variants of the supplying vessels of the vascularized iliac bone graft and their relationship to important surgical landmarks

The iliac bone crest is one of the most valuable regions for harvesting bone grafts, both vascularized and nonvascularized. Since the first commendable description of this region as a possible source for vascularized bone flaps by Taylor, little relevant information concerning the variations of the deep circumflex iliac vessels and their relationship to the neighboring structures has been published. The purpose of the current study was to examine this region clinically and anatomically, taking into consideration the former description by Taylor. We gathered all our findings on 216 iliac regions and proposed a new classification. In addition we measured the relationships between the deep circumflex iliac artery and important surgical landmarks. A comparison of our finding with other studies showed similarities and differences but was far more complete. Generally (92%) the deep circumflex iliac artery (DCIA) originated from external iliac artery (EIA) behind the inguinal ligament (IL) and passed cranio-laterally toward the anterior superior iliac spine, where it divided into two important branches. Four variations were observed of the DCIA. The deep circumflex iliac vein (DCIV) ran over (82.5%) or under (17.5%) the EIA. The superficial circumflex iliac vein (SCIV) was observed draining into the DCIV in some dissections. Three different variations of the superficial circumflex iliac artery (SCIA) were observed. The anatomical knowledge of these variations and their correlation to important surgical landmarks can help in harvesting the DCIA flap more safely and thus increasing the success rate while reducing donor site morbidity.

Usefulness of Vascularized Iliac Bone Graft with Ilizarov External Fixator for Treatment of Severely Injured Ankle Joint : Two Case Reports

Usefulness of Vascularized Iliac Bone Graft with Ilizarov External Fixator for Treatment of Severely Injured Ankle Joint : Two Case Reports

Bone graft scintigraphy

Summary Aim: To evaluate a scintigraphic tool for intra - operative assessment of vascularized bone graft perfusion before and after transplantation. Patients, methods: This pilot study included three patients scheduled for surgical segmental mandibulectomy followed by reconstruction with a vascularized iliac bone graft. A continuous 99mTc-pertechnetate infusion was applied selectively arterial into the blood vessel supplying the respective graft before osteotomy as well as after transplantation. Perfusion was analysed by scintigrams acquired using the intraoperative camera systems declipseSPECT and Sentinella. Results were compared qualitatively. Results: Before harvesting the graft, intraoperative scintigraphy revealed a clearly delineated area of the iliac crest with a relatively homogenous pertechnetate distribution representing good perfusion. After osteotomy, transplantation to the mandibula and re-anastomosis of the nutrient vessels, scintigraphy in all patients showed a moderately inhomogenous distribution pattern of the pertechnetate indicating an adequate perfusion of the bone transplant through the arterial anastomosis. Conclusion: Intraoperative assessment of bone graft perfusion is possible with the imaging systems Sentinella as well as with declipse SPECT using a continuous intra-arterial infusion of 99mTc-pertechnetate.

Die Rekonstruktion der Kahnbeinpseudarthrose mit avaskulärem proximalen Fragment mit freiem mikrovaskulär gestielten Beckenkammtransplantat

The goal of the procedure is osseous healing of the scaphoid in an anatomic position and replacement of necrotic bone at the site of the scaphoid nonunion by a vascularized iliac bone graft. Scaphoid nonunion with necrotic fragment in SNAC (scaphoid nonunion advanced collapse) < 1. Nonunion following previous surgery. Pattern of advanced carpal collapse (SNAC > 1). Malformation, disease or previous injury of the vascular system. Poor compliance. Reduced general health. Principles of the surgical technique according to Pechlaner et al.: harvesting of a corticocancellous bone graft from the anterior iliac crest with a nutrient vascular bundle from the deep circumflex iliac artery, debridement of the necrotic scaphoid, press-fit fixation of the tailored graft, pin fixation, and microvascular anastomosis to the radial artery. Fixation in an upper-arm cast for 4 weeks, followed by lower-arm cast fixation including the thumb to the interphalangeal joint until week 12. Physiotherapy. Wrist splinting in patients enforced to heavy manual load. The described procedure has been practiced at the own institution since 1985 and evaluated in different studies. Using a free vascularized iliac bone graft, union could be achieved in 85% of patients with avascular scaphoid nonunion and in 80% with avascular proximal pole nonunion. The nonunion can be bridged in 93% following failed previous scaphoid screw fixation.

Vascularized Iliac Bone-Grafting for Osteonecrosis with Segmental Collapse of the Femoral Head

Vascularized iliac bone-grafting has been reported to be successful for patients with osteonecrosis of the femoral head. However, its benefit in patients with segmental collapse of the femoral head has not been determined. The purpose of this study was to analyze the results of vascularized iliac grafting in osteonecrotic femoral heads with segmental collapse. We retrospectively analyzed thirty-three hips in thirty-two patients in whom an osteonecrotic femoral head with segmental collapse (Association Research Circulation Osseous [ARCO] stage IIIA [<2-mm collapse] or stage IIIB [2 to 4-mm collapse]) had been treated with vascularized iliac bone-grafting between 1994 and 1999. The average age of the patients at the time of surgery was thirty-seven years. Twenty-six patients (twenty-seven hips) overused alcohol, five patients (five hips) had no known risk factor, and one patient (one hip) used corticosteroids for refractory bronchial asthma. Clinical outcomes were evaluated with the Harris hip score. We defined clinical failure as conversion to total hip replacement for any reason and radiographic failure as progressive femoral head collapse or secondary osteoarthritis of the involved hip. At the conclusion of the study, only eight (24%) of the thirty-three hips were preserved. The mean survival time for the series as a whole was seventy-four months (95% confidence interval, fifty-four to ninety-five months) after the surgery. Eighteen of the twenty-six ARCO stage-IIIA hips were converted to a total hip replacement, and the mean survival time for the stage-IIIA hips was eighty-five months (95% confidence interval, sixty-one to 108 months). All of the seven ARCO stage-IIIB hips were converted to a total hip replacement, and the mean survival time for the stage-IIIB hips was thirty-five months (95% confidence interval, eleven to fifty-eight months). The mean Harris hip score for the eight hips that still survived at the time of follow-up had improved from 62 points to 80 points. However, all of them had progressive collapse of the femoral head-i.e., radiographic failure-at the time of final follow-up. Vascularized iliac bone-grafting with use of the technique described in this study is not indicated for the treatment of osteonecrotic femoral heads with segmental collapse.

Comparison of Donor Site Engraftment After Harvesting Vascularized (V) and Non-Vascularized (NV) Iliac Bone Grafts

Comparison of Donor Site Engraftment After Harvesting Vascularized (V) and Non-Vascularized (NV) Iliac Bone Grafts

Total Calcanectomy and Reconstruction with Vascularized Iliac Bone Graft for Osteoblastoma: A Report of Two Cases

Total Calcanectomy and Reconstruction with Vascularized Iliac Bone Graft for Osteoblastoma: A Report of Two Cases

Vascularized Iliac Bone Graft in Cases of Ankle Tuberculosis

Ankle tuberculosis is a very rare occurrence. Because the ankle is a weightbearing joint, the affected ankle tends to become damaged. Consequently, the surgical procedure of arthrodesis is necessary, which usually proves effective. We report two cases of ankle tuberculosis, in patients 53 and 71 years of age. The former case had been diagnosed initially as osteoarthritis and then later as pyogenic osteomyelitis; the latter case had been diagnosed as pigmented villonodular synovitis, a benign but aggressive lesion that involves the joints. In addition to antitubercular medicine, these cases were treated with debridement for necrotic tissue and arthrodesis. In the former case, an iliac osteocutaneous flap was performed, and arthrodesis between the tibia, talus, and calcaneus was obtained. In the other case, a vascularized iliac bone graft was performed that resulted in arthrodesis between the tarsal bones, talus, and calcaneus but with pseudoarthrosis between the tibia and the talus. Settlement of the joint tuberculosis and gait ability without resorption or corruption of the grafted bone was obtained in both cases. Vascularized bone graft offers the benefits of achieving bone defect reconstruction with promotion of bone union, and the infection can be expected to resolve through medication delivered via the circulation.

Juvenile Metacarpal Bone Missing: Reconstruction by Free Vascularized Iliac Bone Graft Including Its Cartilage for Bone Growth Consideration

Background: Severe crush injury to hand may lead metacarpal bones even carpal bones loss and reconstruction for this injury especially in growing children was a great challenge on shape, function and growth concerns. Vascularized iliac bone graft was mostly used in femoral head necrosis, mandibular defect, tibial osteomyelitis, scaphoid or lunate carpal bone reconstruction, but no report for metacarpal bones missing reconstruction. We here report our experience in 2 cases with a long-standing follow-up. Method: Two cases are in this study. One is a 7 year-old girl suffering from compression and contact burn injury over right hand with 2nd to 5th metacarpal bones loss. The other is a boy with same age suffering from right hand crushing injury with 4th and 5th metacarpal and almost all carpal bones loss. Both received free vascularized iliac osteocutaneous flap for reconstruction. Both have at least 5 years follow-up. Bone length was measured regularly in the clinics. Result: Both patients got acceptable function and appearance. The girl patient had 1.07mm in length and 0.94mm in width and the boy patient had 1.69mm in length and 1.40mm in width of yearly iliac bone growth ini the traumatized hand. The transferred iliac bone graft is growing but slower than the normal hand growing. Conclusion: Although free vascularized iliac bone graft might be a suitable choice of reconstruction for child patient with missing metacarpal and/or carpal bones, further improvement including more iliac crest cartilage and more iliac bone harvest than the measurement from the non-traumatized hand should be considered in the next similar cases.

Long-Term Subjective and Radiological Outcome After Reconstruction of Kienböck’s Disease Stage 3 Treated by a Free Vascularized Iliac Bone Graft

Various vascularized bone grafts are used for surgical treatment of Kienböck's disease. Long-term results of free vascularized iliac bone grafts for treatment of Kienböck's disease are not reported in the literature. The purpose of this study is to report the over-10-year results and to compare them with the 5-year results to determine whether the favorable intermediate-term results were maintained. Eighteen patients with Lichtman stage III were treated with free vascularized iliac bone grafting and followed up for a mean period of 13 years. Assessment included active range of wrist motion, grip strength, level of pain measured using the visual analog scale (VAS), and patient disability and functional outcome measured by the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire as well as the Green and O'Brien score. Radiological evaluation included Ståhl index, Youm carpal height index, radioscaphoid angle (RSA), radiolunate angle (RLA) and integration of the free vascularized bone graft. The long-term results were compared with both the preoperative condition and the 5-year results. Postoperative x-rays showed definite osseointegration of the vascularized bone graft in 89% (16/18). The average flexion-extension arc, the wrist deviation arc, pain, and grip strength improved considerably after surgery, and the results were maintained for a long period. Pronation and supination were not restricted in pre- and postoperative range of motion. The mean DASH score at final follow-up was 8.4 points. The Green and O'Brien score showed 50% excellent, 31% good, and 19% fair results. The average Ståhl index and the average Youm index, improved postoperatively and could be maintained for over 10 years follow-up. Two patients presented with a resorption of the bone graft, with ongoing radiologic progression of Lichtman stage, reduced range of motion, and high pain level. Free vascularized iliac bone grafting for Kienböck's disease is a reasonable treatment option, and clinical and radiological improvements last for a long period of time. Long-term restoration of carpal height could be demonstrated. Progression of disease could be prevented in 89% (16 of 18) of patients over a mean time of 13 years. Therapeutic IV.