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

Several 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.

Custom Presurgical Planning for Midfacial Reconstruction

Resection and reconstruction of midface involve complex ablative and reconstructive tools in head and oncology and maxillofacial prosthodontics. This region is extraordinarily important for long-term aesthetic and functional performance. From a reconstructive standpoint, this region has always been known to present challenges to a reconstructive surgeon due to the complex three-dimensional anatomy, the variable defects created, combination of the medical and dental functionalities, and the distance from reliable donor vessels for free tissue transfer. Another challenge one faces is the unique features of each individual resection defect as well as individual patient factors making each preoperative planning session and reconstruction unique. Understanding the long-term effects on speech, swallowing, and vision, one should routinely utilize a multidisciplinary approach to resection and reconstruction, including head and neck reconstructive surgeons, prosthodontists, speech language pathologists, oculoplastic surgeons, dentists, and/or craniofacial teams as indicated and with each practice pattern. With this in mind, we present our planning and reconstructive algorithm in midface reconstruction, including a dedicated focus on dental rehabilitation via custom presurgical planning.

Analysis of challenging reconstruction of soft tissue defects around the knee joint and evolving a treatment algorithm

<p class="abstract"><strong>Background:</strong> The soft tissue defects around knee joint give a challenging experience to reconstruct. There are various ways to reconstruct soft tissue defects around knee joint. In this study, a reconstructive algorithm is formed for soft tissue defect around knee joint using pedicled flaps.</p><p class="abstract"><strong>Methods:</strong> Reconstructive procedures were done for 15 cases of soft tissue defects around knee joints following different etiologies during the tenure of January 2017 to December 2018 in the Department of Burns, Plastic and Reconstructive Surgery, Kilpauk Medical College, Chennai.<strong></strong></p><p class="abstract"><strong>Results:</strong> Soft tissue defects around knee joint need flap to have a durable cover, to protect the underlying structures – bones, vessels, tendon, and to enable ease of free movement of knee joint without producing contracture. There are various etiologies for soft tissue defects around knee joint-post traumatic injuries, post total knee replacement, post electric burn injuries, post burn scar contracture release of knee joint. 15 cases of soft tissue defects around knee joint were reconstructed using various pedicled flaps-medial thigh rotation flap, gastrocnemius muscle and myocutaneous flap, reverse anterolateral thigh flap, propeller flap. In this retrospective study, reconstructive algorithm for soft tissue defects around knee joint is provided.</p><p class="abstract"><strong>Conclusions:</strong> The reconstruction of soft tissue defects around knee joint is difficult one. In this study, a simple reconstructive algorithm is provided based on the experience in Department of Burns, Plastic, and Reconstructive Surgery, Kilpauk Medical College, Chennai.</p>