• Clinics in Shoulder and Elbow
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• v.15 no.1
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• pp.32-36
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• 2012

Purpose: The purpose of this study was to evaluate the radiologic and clinical outcomes after intercalary tricortical iliac bone graft with plate fixation for the nonunion of midshaft clavicular fractures. Material and Methods: Between September 2007 and May 2011, 10 patients who were treated by the intercalary tricortical iliac bone graft, with plate fixation for clavicle nonunion, were studied. The mean follow-up period was 30.7 (12~57) months. After the sclerotic bone was excised to the bleeding cortical bone, we interposed the tricortical iliac bone to provide structural support and restore clavicle length, and then fixed the plate and screws. The radiologic outcomes on the serial plain radiographs and clinical outcomes, according to UCLA, ASES and Quick DASH scores, were analyzed. Results: Bony union was obtained in all cases (100%) and the average union time was 18.4 (14~24) weeks. The average respective UCLA and ASES scores improved from 16.7 and 52.1 preoperatively to 27.4 and 83.6 postoperatively (p<0.05). The average Quick DASH score was 40.5, at the final follow-up. Complications were 2 shoulder stiffness, and one case had removal of device and arthroscopic surgery at 11 months, postoperatively. There were no implant failure or infection. Conclusion: Intercalary tricortical iliac bone graft, with plate fixation for the nonunion of midshaft clavicular fractures, is a good option that can provide structural support and restore clavicle length, as well as high union rate.

• Archives of Reconstructive Microsurgery
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• v.1 no.1
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• pp.31-38
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• 1992

The management of giant cell tumor involving juxta-articular portion has always been a difficult problem. In certain some giant cell tumors with bony destruction, a wide segmental resection may be needed for preventing to recur. But a main problem is preserving of bony continuity in bony defect as well as preservation of joint function. The traditional bone grafts have high incidence in recurrence rate, delayed union, bony resorption, stress fracture despite long immobilization and stiffness of adjuscent joint. We have attemped to overcome these problems by using a microvascular technique to transfer the fibula with peroneal vascular pedicle as a living bone graft. From Apr. 1984 to Nov. 1990, we performed the reconstruction of wide bone defect after segmental resection of giant cell tumor in 4 cases, using Vascularized Fibular Graft, which occur at the distal radius in 3 cases and at the proximal tibia in 1 case. An average follow-up was 2 years 8 months, average bone defect after wide segmental resection of lesion was 11.4cm. These all cases revealed good bony union in average 6.5months, and we got the wide range of motion of adjacent joint without recurrence and serious complications.

• The Journal of the Korean bone and joint tumor society
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• v.10 no.2
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• pp.96-106
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• 2004

Purpose: To determine the usefulness of limb salvage operation with recycled autogenous bone graft in musculoskeletal malignant tumors. Materials and Methods: Twenty nine cases, who underwent limb salvage operation with recycled autogenous bone graft for the treatment of musculoskeletal malignant tumor between February 1990 and January 2003, were included. There were 18 males and 11 females and the mean age was 33 years (range, 10 to 65 years). The mean follow-up period was 51.8 months (range, 18 to 117 months). The Enneking stage was IIA in 10 cases and IIB in 19 cases. The recycling method of autogenous bone was deep freezing in 6 cases, autoclaving in 11 cases, pasteurization in 7 cases and the composite of autoclaving and vascularized fibular graft in 5 cases. The union of junctional site was evaluated radiologically and the functional results was analyzed by the grading systems of the International Symposium On Limb Salvages (ISOLS). Results: The mean union time was 7.2 months (range, 3 to 15 months). The union took 5.8 months (range, 4 to 8 months) in deep freezing, 9.7 months (range, 6 to 15 months) in autoclaving, 5.9 months (range, 4 to 8 months) in pasteurization, and 5 months (range, 4 to 8 months) in the composite of autoclaving and vascularized fibular graft. The mean functional evaluation percentage was 76.8% (range, 40 to 90%). It was 65.8% (range, 40 to 85%) in deep freezing, 76.6% (range, 40 to 90%) in autoclaving, 81.6% (range, 70 to 90%) in pasteurization, and 83.4% (range, 75 to 90%) in the composite of autoclaving and vascularized fibular graft. There were 6 cases of complications including 1 case of local recurrence, lung metastasis, infection, fracture, respectively and 2 cases of nonunion. Conclusion: The limb salvage operation with recycled autogenous bone graft is a useful treatment method for the musculoskeletal malignant tumors. Particularly, autoclaving is the most reliable sterilization method. The vascularized fibular graft can compensate decreased osteoinductivity and mechanical strength of recycled bone. So, the composite of autoclaving and vascularized bone graft seems to be a favorable treatment method for high grade malignant musculoskeletal tumors.

• Archives of Reconstructive Microsurgery
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• v.15 no.1
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• pp.26-32
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• 2006

Purpose: The purpose of this study was to evaluate the effectiveness of limb reconstruction and functional recovery using vascularized fibular graft in the treatment of extensive bone defect of long bone caused by various diseases. Materials and Methods: From september 1995 to March 2005, 21 patients with segmental bone defects were managed with vascularized fibular graft: 13 males and 8 females, aged 39 years on average (range, $8{\sim}65\;years$). The reconstructed site was the humerus in 9 patients, the femur in 5, the tibia in 4 and the forearm bone in 3. The length of bone defect ranged from $8{\sim}17\;cm$. Results: Twenty grafts were successful. The mean period to obtain radiographic bone union was 5.7 months on average. Conclusion: Fibular grafts allow the use of a segment of diaphyseal bone and of sufficient length to reconstruct most skeletal defects of the long bone. The vascularized fibular graft is indicated in patients with intractable nonunions where conventional bone grafting has failed or large bone defects.

• The Journal of the Korean bone and joint tumor society
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• v.9 no.2
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• pp.139-147
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• 2003

Purpose: The purpose of this study was to determine if bony union can be obtained when a bone graft substitute is transplanted in order to treat a benign bone tumor and if there is a difference between calcium sulfate and hydroxyapatite in the healing procedure when the degree of the bony union after the bone graft are compared. Materials and Methods: This study selected 20 cases, in which a curettage on the benign bone tumors was conducted and a bone graft substitute was transplanted. The area of the focus, the new bone formation, the recurrence of the focus in the plain radiographs and histological findings were observed. Results: Twenty cases (13 males, 7 females) were evaluated. Their mean age at surgery was 15.8 years (2~45), and the mean follow-up period was 3 years. The mean area of focus was 30.7 $cm^3$ in the radiographs, and 19 cases showed successful results in the ultimate visit, while 1 case has a recurrence of the focus. Conclusion: Calcium sulfate has osteoconduction and superior bioavailability, and is absorbed in vivo in proportion to the new bone formation. On the other hand, hydroxyapatite has good osteoconduction. It can result in better bone formation when it is combined with an autologous bone graft, autologous bone marrow, and an allogenic bone graft, but is absorbed in vivo more slowly than the former.

• Archives of Reconstructive Microsurgery
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• v.2 no.1
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• pp.20-28
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• 1993

From 1981 to 1991, twenty one vascularized bone grafts had been performed for the treatment of large bone defects of the extremities, with average follow-up of 65.4 months. Fibulae were used in 15 patients Including two cases of osteocutaneous flap, iliums in 5 including two of osteocutaneous flap, and osteocutneous rib in one. Ten of these patients were treated for segmental defects derived from trauma or infection sequelae of long bones, while eight for locally aggressive benign or malignant bone tumors ; and three for congenital pseudarthrosis of tibia. The location of the lesions were 8 cases in tibia; 7 in humerus ; 3 in forearm bone ; 2 in foot ; and 1 in femur. The length of bone defects were averaged as 10 cm, ranging from 3 to 17.5. In eighteen patients(85.7%), the operation was successful. The duration from operation to bony union was average 5.1 months on successful cases, and three of them needed additional procedures, such as bone graft and electrical stimulation to promote bony union. Local recurrence was found in one case of chondrosarcoma, resulting in AK amputation. Wound infections were noted each one case on donor or recipient site. In five cases, the fracture of grafted bone, which united with cast immobilization in four, occurred average 16.7 months after operation.

• Archives of Reconstructive Microsurgery
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• v.6 no.1
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• pp.63-72
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• 1997

We have evaluated the clinical results following the 46 cases of free vascularized osteocutaneous fibular flap transfer to the tibial defect combined with skin and soft tissue defect, which were performed from May 1982 to January 1997. Regarding to the operation, flap size, length of the grafted fibula, anastomosed vessels, ischemic time of the flap and total operation time were measured. After the operation, time to union of grafted fibula and the amount of hypertrophy of grafted fibula were periodically measured through the serial X-ray follow-up and also the complications and results of treatment were evaluated. In the 46 consecutive procedures of free vascularized osteocutaneous fibular flap transfer, initial bony union were obtained in the 43 grafted fibulas at average 3.75 months after the operation. There were 2 cases in delayed unions and 1 in nonunion. 44 cutaneous flaps among the 46 cases were survived but 2 cases were necrotized due to deep infection and venous insufficiency. One necrotized flap was treated with latissimus dorsi free flap transfer and the other was treated with soleus muscle rotational flap. Grafted fibulas have been hypertrophied during the follow-up periods. The fracture of grafted fibula(15 cases) was the most common complication and occurred at average 9.7 months after the operation. The fractured fibulas were treated with the cast immobilization or internal fixation with conventional cancellous bone graft. In the cases of tibia and fibula fracture at recipient site, the initial rigid fixation for the fibula fracture at recipient site could prevent the fracture of grafted fibula to the tibia.

• Archives of Reconstructive Microsurgery
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• v.3 no.1
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• pp.9-15
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• 1994

It is difficult to obtain a satisfactory bony union of large bone defect secondary to trauma, tumor resection, congenital pseudarthrosis of tibia and bony metaplasia following infection with conventional methods. Conventional nonvascularized autologous bone graft do not provide adequate large amounts of donor bone and usually undergo necrosis or nonunion due to lack of vascular nutrition. Currently, advanced in microsurgery have made it possible to provide a continuing circulation of blood in bone grafts so as to ensure viability. With the nutrient blood supply preserved, healing of the graft to the recipient bone is facilitated without the usual replacement of the graft by creeping substitution. Thus, the grafted bone is achieved more rapid stabilization without sacrificing viability. We reviewed 11 cases of vascularized fibular grafts which were performed from December 1982 to January 1993 and the following results were obtained: 1. Large bone defects with chronic osteomyelitis secondary to trauma were could be successfully treated by the vascularized fibular transfer. 2. In our experience, the vascularized fibular transfer was thought to be one of good methods of treatment for congenital pseudathrosis of tibia. 3. Complete tumor resection was followed by a free vascularized fibular transfer, resulting in good functional improvement, without local recurrence. Long bone defect secondary to bony dysplasia was could be reconstructed by the vascularized fibular transfer. 4. The transferred vascularized fibula had been hypertrophied with bony union during follow-up period and there was no resorption of the grafted fibula.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.134-138
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• 2000

Arthrodesis of the ankle joint is inevitable in the cases of severe arthrosis or defective bony structures around ankle joint. There have been many kinds of arthrodesis methods were introduced. In cases with failed athrodesis with previous arthrodesis surgery and neuropathic joints have difficulty to achieve fusion of joint with conventional methods. Authors underwent four cases of ankle fusion with vascularized fibular graft from 1997 in the cases of three failed fusions and one diabetic neuropatic joint. Two of four performed free vascularized fibular transplantation from contralateral side leg with microvascular anastomosis, two of four performed with pedicled fibular transposition to the ankle joint in same side leg. Three of four cases achieved arthrodesis average 9.2 months after surgery, one case was failed due to vascular thrombosis of the anastomosed site in diabetic neuropathic condition. The result of this technique revealed 75%(three of four) success rate and longer bone union time required. However, in these cases had no recommendable options with conventional bone graft and additional ankle joint fusions procedure because of poor bone quality and defect of distal tibia and talus portions. Free vascualrized fibular transfer to the failed athrodesis of ankle joint is one of the effective alternative methods in failed ankle fusion cases, especially the quality of the bone around previous fusion site is poor.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.6
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• pp.466-472
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• 2012

The loss of mandibular continuity due to trauma, neoplasm, or infection results in major esthetic and biologic compromise. The reconstruction of the mandibular bone defect still poses a challenge to oral and maxillofacial surgeons. There have been a number of variety graft materials. Among them, free block bone graft with rigid fixation has been widely used. However, cases using free block bone grafts may lead to a marked invasion of the donor site, mal-union, and absorption of the block bone. In this respect, particulate cortical bone using a titanium mesh tray can be an effective alternative option in order to achieve a proper bone contour and good oral rehabilitation. We have developed an intraoral approach for the mandibular reconstruction method using a titanium mesh tray with autogenous particulate cortical bone graft.