Algorithm of surgical treatment of large bone defects of long tubular bones by vascularized bone grafting

Author:

Ladutko D. Yu.1,Podhaisky V. N.2,Ladutko Yu. N.2,Pekar A. V.1,Kezlya O. P.2,Selitsky А. V.2,Gubicheva A. V.2

Affiliation:

1. Minsk Regional Clinical Hospital

2. The Belarus Medical Academy Postgraduate Formations

Abstract

The purpose of this study was to develop a clinical classification of large defects of long tubular bones of the extremities and protocols for surgical treatment by vascularized bone grafting.Material and methods. The results of treatment of 51 patients with large defects of the long tubular bones of the upper and lower extremities were analyzed. In 25 cases, along with bone defects, there were significant defects of the soft tissues of the limb with trophic and scar changes. In order to replace the bone defect vascularized grafts were used: bone-muscular fibular, bone-cutaneous fibular, bone-cutaneous iliac, bone-cutaneous radial, bone-cutaneous tibial, and combined bone-cutaneous fibular with an allograft from the tibia. The results of treatment of patients were evaluated according to the clinical criteria of R. Johner, O. Wruhs (1983), proposed for the lower limb. The DASH questionnaire was use to evaluate the results of treatment for upper limb defects.The results and discussion. The classification is based on 4 variable criteria: the size, anatomical localization of the bone defect, the size of the soft tissue defect and the shortening of the damaged limb segment. The size and anatomical location of the defect in the long tubular bone is important in choosing a bone flap. Based on the anatomical localization of the bone defect, soft tissue damage and limb shortening, the patients were classified into 4 types. The first 3 types were divided into 2 subtypes, depending on the size of bone damage and soft tissues defect of the limb. Based on the proposed classification, we have developed protocols for microsurgical reconstruction of large bone defects of the extremities for each subtype of bone defect.Conclusion. The application of the developed clinical classification of large bone defects of long tubular bones and protocols for their surgical treatment by vascularized bone grafting made it possible to restore limb function in 96% of cases.

Publisher

Research Institute of Microsurgery

Reference12 articles.

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