Vascularized Bone Grafts in Spinal Reconstruction: An Overview of Nomenclature and Indications

AbstractSeveral vascularized bone grafts (VBGs) have been introduced for reconstruction and augmenting fusion of the spine. The expanding use of VBGs in the field of spinoplastic reconstruction, however, has highlighted the need to clarify the nomenclature for bony reconstruction as well as establish the position of VBGs on the bony reconstructive algorithm. In the current literature, the terms “flap” and “graft” are often applied inconsistently when describing vascularized bone transfer. Such inconsistency creates barriers in communication between physicians, confusion in interpreting the existing studies, and difficulty in comparing surgical techniques. VBGs are defined as bone segments transferred on their corresponding muscular attachments without a named major feeding vessel. The bone is directly vascularized by the muscle attachments and unnamed periosteal feeding vessels. VBGs are best positioned as a separate entity in the bony reconstruction algorithm between nonvascularized bone grafts (N-VBGs) and bone flaps. VBGs offer numerous advantages as they supply fully vascularized bone to the recipient site without the microsurgical techniques or pedicle dissection required for raising bone flaps. Multiple VBGs have been introduced in recent years to optimize these benefits for spinoplastic reconstruction.

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Experience of using vascularized bone grafts to treat nonunion fractures and limb bone defects

Transplantologiya The Russian Journal of Transplantation ◽

10.23873/2074-0506-2019-11-1-9-20 ◽

2019 ◽

Vol 11 (1) ◽

pp. 9-20

Author(s):

A. V. Nevedrov ◽

E. Yu. Shibayev ◽

V. O. Kalenskiy ◽

N. N. Zadneprovskiy ◽

V. B. Shishkin ◽

...

Keyword(s):

Bone Graft ◽

Three Dimensional ◽

Bone Grafts ◽

Bone Defects ◽

Virtual Planning ◽

Recipient Site ◽

Limb Bone ◽

Bone Nonunion ◽

Dimensional Printing ◽

Vascularized Bone

Background.Vascular bone graft transposition is the one of most effective method of nonunion fracture and bone defect treatment. However, the use of this technique is associated with some difficulties. One is the adjustment of recipient bed size and the graft. The other is the difficulty to reconstruct the alignment and length of bone. A promising method of preparing for the vascular bone graft transposition is virtual three-dimensional planning based on computed tomography data and three-dimensional printing templates.The aimwas to summarize our experience in the treatment of bone nonunion and defects with vascular bone autografts using tree-dimensional virtual planning and printing.Material and methods.We analyzed the treatment process and outcomes of 4 patients with limb bone nonunion and 6 patients with bone defects. In all cases, we used vascular bone grafts. Internal fixation of grafts was used in 7 cases, external fixation was used in 3 cases. At preparation stage in 4 cases, we used tree-dimensional virtual surgery planning and printing templates.Results.One case was diagnosed with bone graft necrosis caused by venous thrombosis. Consolidation was achieved in all patients; a late consolidation was observed in 2 cases. Hematoma in donor area was seen in 2 patients. When using three-dimensional virtual planning and tree-dimensional printing templates, the operation time was decreased by 1 hour 5 minutes. We identified two cases of poor reposition in the group without virtual planning. No poor reposition was observed in the cases where tree-dimensional planning was used.Conclusion.Vascularized bone grafts provide an effective method to treat bone defects and nonunion. But the planning of graft and recipient site sizes is associated with certain difficulties. Our preliminary results have shown that virtual three-dimensional planning and printing allow improving the precision of the surgical procedure and decreasing operative time.

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Vascularized Bone Grafts for Spinal Fusion—Part 4: The Scapula

Operative Neurosurgery ◽

10.1093/ons/opab034 ◽

2021 ◽

Vol 20 (5) ◽

pp. 508-512

Author(s):

Edward M Reece ◽

Matthew J Davis ◽

Amjed Abu-Ghname ◽

Edward Chamata ◽

Scott Holmes ◽

...

Keyword(s):

Operative Time ◽

Bone Grafts ◽

Technical Note ◽

Surgical Experience ◽

Structural Support ◽

Spinal Reconstruction ◽

Novel Approach ◽

Cadaver Studies ◽

Vascularized Bone

Abstract BACKGROUND Solid arthrodesis is the long-term goal of most spinal reconstruction surgeries. A multitube of biologics as well as autograft is commonly used to augment the bony fusion. Medial scapular vascularized bone grafts (S-VBGs) are a novel approach to supplement cervicothoracic arthrodesis in patients at high risk for failed fusion. OBJECTIVE To discuss the benefits of using a vascularized scapular graft, pedicled to the rhomboid minor, compared to both nonvascularized bone grafts and free vascularized bone grafts, as well as the surgical technique, feasibility, and nuances of the surgical experience with an S-VBG. METHODS The anatomic feasibility of this procedure has been established in cadaver studies. This technical note details the operative steps and presents the first surgery in which a vascularized scapular graft was used to supplement cervicothoracic arthrodesis. RESULTS A single patient with complex cervical deformity was successfully treated with this novel arthrodesis approach. CONCLUSION Vascularized scapula grafts, pedicled on the rhomboid minor, provides both structural support and a source of vascularized autograft to a cervicothoracic arthrodesis. It leverages the benefits of a free-flap bone with less operative time and morbidity.

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Mandibular Reconstruction Using Vascularized Bone Grafts

Otolaryngologic Clinics of North America ◽

10.1016/s0030-6665(20)31043-4 ◽

1991 ◽

Vol 24 (6) ◽

pp. 1391-1418 ◽

Cited By ~ 1

Author(s):

Daniel B. Kuriloff ◽

Michael J. Sullivan

Keyword(s):

Bone Grafts ◽

Mandibular Reconstruction ◽

Vascularized Bone

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Some Available Vascularized Bone Grafts in Posttraumatic Hand Reconstruction

Journal of Reconstructive Microsurgery ◽

10.1055/s-2005-918986 ◽

2005 ◽

Vol 21 (07) ◽

Author(s):

Alexandru Georgescu ◽

Ovidiu Ivan ◽

Adrian Avram ◽

Ileana Matei ◽

Irina Capota

Keyword(s):

Bone Grafts ◽

Hand Reconstruction ◽

Vascularized Bone

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Rigid Fixation of Vascularized Bone Grafts in Mandibular Reconstruction

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archotol.1995.01890010056010 ◽

1995 ◽

Vol 121 (1) ◽

pp. 70-76 ◽

Cited By ~ 43

Author(s):

N. D. Futran ◽

M. L. Urken ◽

D. Buchbinder ◽

J. F. Moscoso ◽

H. F. Biller

Keyword(s):

Bone Grafts ◽

Mandibular Reconstruction ◽

Rigid Fixation ◽

Vascularized Bone

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Primary Malignant Orbital Tumors

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1722635 ◽

2021 ◽

Vol 82 (01) ◽

pp. 081-090

Author(s):

Jacquelyn Laplant ◽

Kimberly Cockerham

Keyword(s):

Multimodal Therapy ◽

Surgical Techniques ◽

Surgical Approaches ◽

Imaging Features ◽

Orbital Surgery ◽

Diagnosis And Management ◽

Microsurgical Techniques ◽

Invasive Techniques ◽

Traditional Approaches ◽

Orbital Imaging

Abstract Objective Primary orbital malignancy is rare. Awareness of the characteristic clinical and imaging features is imperative for timely identification and management. Surgery remains an important diagnostic and treatment modality for primary orbital malignancy, but determining the optimal surgical approach can be challenging. The purpose of this article is to explore recent advances in the diagnosis, management, and surgical approaches for primary orbital malignancies. Design In this review, the clinical presentation, imaging features, and medical and surgical management of primary orbital malignancies with representative cases will be discussed. Setting Outpatient and inpatient hospital settings. Participants Patients with diagnosed primary orbital malignancies. Main Outcome Measures Descriptive outcomes. Results Advancements in orbital imaging, microsurgical techniques, and multimodal therapy have improved the diagnosis and management of primary orbital malignancies. Special considerations for biopsy or resection are made based on the tumor's location, characteristics, nearby orbital structures, and goals of surgery. Minimally invasive techniques are supplanting traditional approaches to orbital surgery with less morbidity. Conclusions Advances in imaging technologies and surgical techniques have facilitated the diagnosis and management of primary orbital malignancies. Evolution toward less invasive orbital surgery with focus on preservation and restoration of function is underway.

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