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Bone nonunion management in children with a vascularized tibial periosteal graft
Author(s) -
Soldado Francisco,
BarreraOchoa Sergi,
BerguaDomingo Josep Maria,
Domenech Pedro,
Corona Pablo Salvador,
Knorr Jorge
Publication year - 2020
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.30655
Subject(s) - medicine , nonunion , surgery , tibia , pseudarthrosis , bone healing , long bone , orthopedic surgery
Background Vascularized periosteal graft have demonstrated a tremendous bone healing capacity in children. The objective is to report outcomes on the use of vascularized tibial periosteal graft (VTPG) during bone reconstruction in a series of children with complex bone healing problems. Patients and methods Cases were collected retrospectively since May 2013 to May 2019, excluding cases of congenital pseudarthrosis of the tibia. Mean age at surgery was 12.8 (range 11–18) years. Indications included treatment of recalcitrant bone nonunion and the prevention of bone allograft‐host junction nonunion in seven and three patients, respectively. The periosteal flap, based on the anterior tibial vessels, was harvested as a free flap in six instances and as a pedicled flap in four. Results Mean follow‐up was 25.2 months (range 8–36). The flap showed a 13.6 cm (range 9–16) and mean width 3.4 cm (range 2.7–3.9). Early bone union was achieved, initially through periosteal callus, followed by cortical union at mean times of 2 and 4 months, respectively, in nine cases. The flap was not successful in a patient with severe comorbidities. No donor site complications were registered. Conclusions VTPG was fast and high effective for the treatment complex bone nonunion or the prevention of allograft nonunion in children.