血管化纤维移植在前臂骨缺失中的应用：从初始治疗到继发性不愈合治疗

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-03-01 DOI:10.1016/j.jhsg.2024.08.004

Bruno Battiston MD, PhD , Francesca Fissore MD , Elisabetta Mijno MD , Davide Ciclamini MD

{"title":"血管化纤维移植在前臂骨缺失中的应用：从初始治疗到继发性不愈合治疗","authors":"Bruno Battiston MD, PhD , Francesca Fissore MD , Elisabetta Mijno MD , Davide Ciclamini MD","doi":"10.1016/j.jhsg.2024.08.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>Managing mangled forearms poses a considerable challenge for hand surgeons. The vascularized fibular graft (VFG) is a commonly used technique for addressing this complex issue. This retrospective study aims to assess the outcomes of advanced treatment for complex forearm bone loss necessitating microsurgical treatment with a vascularized fibula flap.</div></div><div><h3>Methods</h3><div>Patients treated with VFG between January 2010 and December 2022 were included in this analysis. Physical and radiographic evaluations were performed for all patients, and they completed patient-reported outcome measures such as the disability of the arm, shoulder, and hand scores, Mayo Wrist scores, and visual analog scale pain (VAS-Pain) scores for both the recipient and donor sites. Patients treated with one-bone forearm (OBF) reconstruction were also assessed using the outcome score of the OBF according to Peterson.</div></div><div><h3>Results</h3><div>A total of 26 cases were treated with VFG for forearm bone defect reconstruction (13 for primary treatment and 13 for secondary treatment of nonunion). Vascularized fibular graft was employed to create a OBF in four cases, a double barrel in three cases, and an osteocutaneous composite flap in nine cases. The average bone defect measured 81 ± 3.4 mm (range: 50–150 mm). Bone healing was achieved at an average of 8.3 ± 5.5 months (range: 4–15 months), with nonunion at one docking point observed in eight cases necessitating revision. At the follow-up end point, patients reported an average disability of the arm, shoulder, and hand score of 13.5%, a Mayo Wrist score of 80%, and a VAS-Pain score of 3/10. The VAS-Pain outcome at the donor site was rated at 4/10. One-bone forearm’s mean score was 7/10.</div></div><div><h3>Conclusions</h3><div>Vascularized fibular graft stands as a viable option for mangled forearm reconstruction. Whether through the double barrel technique or as an osteocutaneous composite graft, VFG allows for the simultaneous reconstruction of both forearm bones and associated soft tissue injuries.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 356-361"},"PeriodicalIF":0.0000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Versatility of Vascularized Fibular Graft in Forearm Bone Loss: From Initial Treatment to Secondary Nonunion Treatment\",\"authors\":\"Bruno Battiston MD, PhD , Francesca Fissore MD , Elisabetta Mijno MD , Davide Ciclamini MD\",\"doi\":\"10.1016/j.jhsg.2024.08.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><div>Managing mangled forearms poses a considerable challenge for hand surgeons. The vascularized fibular graft (VFG) is a commonly used technique for addressing this complex issue. This retrospective study aims to assess the outcomes of advanced treatment for complex forearm bone loss necessitating microsurgical treatment with a vascularized fibula flap.</div></div><div><h3>Methods</h3><div>Patients treated with VFG between January 2010 and December 2022 were included in this analysis. Physical and radiographic evaluations were performed for all patients, and they completed patient-reported outcome measures such as the disability of the arm, shoulder, and hand scores, Mayo Wrist scores, and visual analog scale pain (VAS-Pain) scores for both the recipient and donor sites. Patients treated with one-bone forearm (OBF) reconstruction were also assessed using the outcome score of the OBF according to Peterson.</div></div><div><h3>Results</h3><div>A total of 26 cases were treated with VFG for forearm bone defect reconstruction (13 for primary treatment and 13 for secondary treatment of nonunion). Vascularized fibular graft was employed to create a OBF in four cases, a double barrel in three cases, and an osteocutaneous composite flap in nine cases. The average bone defect measured 81 ± 3.4 mm (range: 50–150 mm). Bone healing was achieved at an average of 8.3 ± 5.5 months (range: 4–15 months), with nonunion at one docking point observed in eight cases necessitating revision. At the follow-up end point, patients reported an average disability of the arm, shoulder, and hand score of 13.5%, a Mayo Wrist score of 80%, and a VAS-Pain score of 3/10. The VAS-Pain outcome at the donor site was rated at 4/10. One-bone forearm’s mean score was 7/10.</div></div><div><h3>Conclusions</h3><div>Vascularized fibular graft stands as a viable option for mangled forearm reconstruction. Whether through the double barrel technique or as an osteocutaneous composite graft, VFG allows for the simultaneous reconstruction of both forearm bones and associated soft tissue injuries.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>\",\"PeriodicalId\":36920,\"journal\":{\"name\":\"Journal of Hand Surgery Global Online\",\"volume\":\"7 2\",\"pages\":\"Pages 356-361\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Hand Surgery Global Online\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2589514124001610\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hand Surgery Global Online","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589514124001610","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

摘要

目的：前臂骨折的处理对手外科医生来说是一个相当大的挑战。带血管腓骨移植（VFG）是解决这一复杂问题的常用技术。本回顾性研究的目的是评估复杂的前臂骨丢失，需要显微手术治疗血管带腓骨皮瓣的先进治疗的结果。方法纳入2010年1月至2022年12月期间接受VFG治疗的患者。对所有患者进行了物理和放射学评估，并完成了患者报告的结果测量，如手臂、肩部和手部的残疾评分，Mayo手腕评分，以及受体和供体部位的视觉模拟疼痛量表（VAS-Pain）评分。根据Peterson的说法，接受单骨前臂（OBF）重建治疗的患者也使用OBF的结果评分进行评估。结果26例前臂骨缺损行VFG修复，其中13例为初级治疗，13例为二级治疗。带血管腓骨移植物4例，双管式腓骨移植物3例，骨皮复合皮瓣9例。骨缺损平均为81±3.4 mm（范围50-150 mm）。骨愈合平均为8.3±5.5个月（范围：4-15个月），8例患者在一个对接点观察到骨不连，需要翻修。在随访结束时，患者报告手臂、肩部和手部的平均残疾评分为13.5%，Mayo手腕评分为80%，VAS-Pain评分为3/10。供体部位VAS-Pain评分为4/10。单骨前臂平均评分为7/10。结论带血管腓骨移植物是前臂畸形重建的可行选择。无论是通过双管技术还是作为骨-皮复合移植物，VFG都可以同时重建前臂骨和相关的软组织损伤。研究类型/证据水平治疗性IV。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Versatility of Vascularized Fibular Graft in Forearm Bone Loss: From Initial Treatment to Secondary Nonunion Treatment

Purpose

Managing mangled forearms poses a considerable challenge for hand surgeons. The vascularized fibular graft (VFG) is a commonly used technique for addressing this complex issue. This retrospective study aims to assess the outcomes of advanced treatment for complex forearm bone loss necessitating microsurgical treatment with a vascularized fibula flap.

Methods

Patients treated with VFG between January 2010 and December 2022 were included in this analysis. Physical and radiographic evaluations were performed for all patients, and they completed patient-reported outcome measures such as the disability of the arm, shoulder, and hand scores, Mayo Wrist scores, and visual analog scale pain (VAS-Pain) scores for both the recipient and donor sites. Patients treated with one-bone forearm (OBF) reconstruction were also assessed using the outcome score of the OBF according to Peterson.

Results

A total of 26 cases were treated with VFG for forearm bone defect reconstruction (13 for primary treatment and 13 for secondary treatment of nonunion). Vascularized fibular graft was employed to create a OBF in four cases, a double barrel in three cases, and an osteocutaneous composite flap in nine cases. The average bone defect measured 81 ± 3.4 mm (range: 50–150 mm). Bone healing was achieved at an average of 8.3 ± 5.5 months (range: 4–15 months), with nonunion at one docking point observed in eight cases necessitating revision. At the follow-up end point, patients reported an average disability of the arm, shoulder, and hand score of 13.5%, a Mayo Wrist score of 80%, and a VAS-Pain score of 3/10. The VAS-Pain outcome at the donor site was rated at 4/10. One-bone forearm’s mean score was 7/10.

Conclusions

Vascularized fibular graft stands as a viable option for mangled forearm reconstruction. Whether through the double barrel technique or as an osteocutaneous composite graft, VFG allows for the simultaneous reconstruction of both forearm bones and associated soft tissue injuries.