Reconstruction of post-traumatic long segment bone defects of the lower end of the femur by free vascularized fibula combined with allograft (modified Capanna鈥檚 technique)

详细信息    查看全文

• 作者：H. Venkatramani (1)
  S. R. Sabapathy (2)
  J. Dheenadayalan (3)
  A. Devendra (3)
  S. Rajasekaran (4)
  
  1. Department of Plastic Surgery ; Hand and Reconstructive Surgery and Burns ; Ganga Hospital ; Coimbatore ; India
  2. Division of Plastic Surgery ; Hand and Reconstructive Microsurgery and Burns ; Ganga Hospital ; 313 ; Mettupalayam Road ; Coimbatore ; 641043 ; India
  3. Department of Orthopaedics ; Ganga Hospital ; Coimbatore ; India
  4. Division of Spine ; Orthopaedics and Trauma ; Ganga Hospital ; Coimbatore ; India
  
• 关键词：Reconstruction long segment bone loss ; Femur defect ; Free fibula ; Allograft ; Capanna technique
• 刊名：European Journal of Trauma and Emergency Surgery
• 出版年：2015
• 出版时间：February 2015
• 年：2015
• 卷：41
• 期：1
• 页码：17-24
• 全文大小：1,088 KB
• 参考文献：1. Saridis A, Panagiotopoulos E, Tyllianakis M, Matzaroglou C, Vandoros N, Lambiris E. The use for the Ilizarov method as a salvage procedure in infected nonunion of the distal femur with bone loss. J Bone Joint Surg (Br). 2006;88:232鈥?. CrossRef
  2. Berlusconi M, Chiodinni F, Cavanna M. Allograft for the treatment of massive bone loss in open and infected IIIA fracture of the distal femur. J Orthop. 2012; 4 (2): 55鈥?0.
  3. Muramatsu K, Ihara K, Doi K, Shigetomi M, Hashimoto T, Taguchi T. Reconstruction of massive femur defect with free vascularized fibula graft following tumour resection. Anticancer Res 2006; 26: 3679鈥?684.
  4. Peterson MM, Hovgaard D, Elberg JJ, Rechnitzer C, Daugaard S, Muhic A. Vascularized fibula grafts for reconstruction of bone defects after resection of bone sarcomas. Sarcoma. Volume 2010; Article ID 524721. doi:10.1155/2010/524721 .
  5. Rabitsch K, Maurer-Ertl W, Pirker-Fruhauf U, Wibmer CM, Leithner A. Intercalary reconstructions with vascularised fibula and allograft after tumour resection in the lower limb. Sarcoma. Volume 2013; Article ID 160295.
  6. Zaretki A, Amir A, Meller I, Leshem D, Kollender Y, Barunea Y, Bickels J, Shapitzer T, Ad-El D, Gur E. Free fibula long bone reconstruction in orthopaedic oncology: a surgical algorithm for reconstructive options. Plast Reconstr Surg. 1989;113:1989鈥?000. CrossRef
  7. Chotel F, Nguiabanda L, Braillon P, Kohler R, Berard J, Abelin-Genevois K. Induced membrane technique for reconstruction after bone tumour resection in children: a preliminary study. Orthop Traumatol Surg Res. 2012;98:301鈥?. CrossRef
  8. Wong TM, Lau TW, Li X, Fang C, Yeung K, Leung F. Masquelet technique for treatment of posttraumatic bone defects. Sci World J. Volume 2014; Article ID 710302.
  9. D鈥橝gostino P, Stassen P, Delloye C. Post-traumatic bone loss of the femur treated with segmental bone allograft and bone morphogenetic protein: a case report. Acta Orthop Belg. 2007;73:396鈥?.
  10. A report by the British Orthopaedic Association/British Association of Plastic Surgeons Working Party on the Management of Open Tibial Fractures September 1997. Br J Plast Surg. 1997; 50(8): 570鈥?83.
  11. Capanna R. Bufalini c, Campanacci M. A new technique for reconstruction of large metadiaphyseal bone defects. A combined graft allograft shell plus vascularized fibula. Orthop Traumatol. 1993;2(3):159鈥?7. CrossRef
  12. Ridha H, Bernard J, Gaeley D, Vesely MJ. Reconstruction of large traumatic segmental defects of the femur using segmental allograft with vascularized fibula inlay. J Reconstr Microsurg. 2011;27:383鈥?. CrossRef
  13. Venkatramani H, Sabapathy SR, Nayak S. Free-flap cover of complex defects around the knee using the descending genicular artery as the recipient pedicle. J Plast Reconstr Aesthetic Surg. 2014;67(1):93鈥?. CrossRef
  14. Bakri K, Stans AA, Mardini S, Moran SL. Combined massive allograft and intramedullary vascularized fibula transfer: the Capanna technique for lower-limb reconstruction. Seminars in Plastic Surgery. 2008;22(3):234鈥?1. CrossRef
  15. Zheng-gang BI, Xin-guang H, Chun-jiang F, Yang CAO, Cheng-lin Y. Reconstruction of larger limb bone defects with a double-barrel free vascularized fibular graft. Chin Med J. 2008;121(23):2424鈥?.
  16. Chu CH, Jou IM, Shieh SJ. Reconstruction of a massive femoral bone defect using a double-barreled free vascularized fibular bone graft after wide resection of femoral chondrosarcoma. Kaohsiung J Med Sci. 2009;25:552鈥?. CrossRef
  17. Donati D, Di Bella C. Col angeli M, Bianchi G, Mercuri M. The use of massive bone allografts in bone tumour surgery of the limb. Curr Orthop. 2005;19:393鈥?. CrossRef
  18. Ceruso M, Taddei F, Biagazzi P, Manfrini M. Vascularised fibula graft inlaid in a massive bone allograft: considerations on the bio-mechanical behavior of the combined graft in segmental bone reconstructions after sarcoma resection. Injury Int J Care Injured. 2008;395:568鈥?4.
  19. Chang DW, Weber KL. Use of a vascularised fibula bone flap and intercalary allograft for diaphyseal reconstruction after resection of primary extremity bone sarcomes. Plast Reconstr Surg. 2005;116:1918鈥?5. CrossRef
  20. Manfrini M, Vanel D, De Paolis M, Malaguti C, Innocenti M, Ceruso M, Capanna R, Mercuri M. Imaging of vascularized fibula autograft placed inside a massive allograft in reconstruction of lower limb bone tumours. AJR. 2004;182:963鈥?0. CrossRef
  21. Lasanianos NG, Kanakaris NK, Giannoudis PV. Current management of long bone large segmental defects. Orthop Trauma. 2009;24(2):149鈥?3. CrossRef
  
• 刊物主题：Traumatic Surgery; Surgical Orthopedics; Emergency Medicine; Sports Medicine; Intensive / Critical Care Medicine; Surgery;
• 出版者：Springer Berlin Heidelberg
• ISSN：1863-9941

文摘

Purpose Salvage of long segment bone loss in the limbs particularly near the joints continues to be a challenge to the trauma surgeon. None of the techniques available are universally successful and all share the disadvantages of multi-staged procedures. A reliable single-stage technique would be ideal to reduce the treatment time and the cost of care. We are presenting here our experience of successfully using the modified Capanna technique of combining allograft and free vascularized fibular graft in treating large bone defects in the distal third of the femur. Methods Between April 2012 and October 2013, six patients with post-traumatic long segment bone loss in the distal femur had reconstruction of the bone defect by the Capanna technique. The average age was 33聽years (range of 18鈥?9聽years). The bone defect ranged from 10 to 20聽cm (average 15聽cm). Five patients had primary reconstruction while one was done after allograft failure. Bone union time and occurrence of any complications were noted. Follow-up ranged from 7 to 24聽months (average 15聽months). Results All grafts went onto union. No patient required secondary procedure to achieve union. Average time to union was 6聽months. One patient had deep infection and delayed union of distal end of the fibula graft. Conclusion Free vascularized fibular graft combined with allograft increases initial stability, allows early weight bearing, has higher chances of union and is a good single-stage technique of reconstruction of distal third femur defects.