The anatomical basis of the vascularized fibularis brevis grafts / Base anatómica de los injertos vascularizados del músculo fibularis brevis

Fibularis brevis grafts have been extensively used, especially as distally-based grafts, to cover defects in the lower leg and foot. The study has contributed to analyze the blood supply of the fibularis brevis muscle and the vascular basis of its possible different grafts. Both legs of twelve preserved cadavers, without congenital vascular anomalies, were utilized in the study. Fibularis brevis was exposed in all selected legs along with the verification of different arterial pedicles. The total means and standard deviations of the length and width of the muscle together with diameters of major vessels were calculated. Total length and width of middle portion of fibularis brevis were at means of 28.7±0.4 cm and 3±0.02 cm respectively. The upper and middle portions of the muscle were supplied by the fibular and the anterior tibial artery. The middle portion was supplemented by the upper perforating branch of the posterior tibial artery. The lower portion of the muscle was supplied by the lower perforating branch of the posterior tibial and the periosteal arteries. The muscle could be used as a proximally or distally based flap, free vascularized muscle graft, free vascularized osteo-muscular flap, and distally-based split flap. It can be split completely into two flaps; each of which can be used as a proximally or distally.

Los injertos de músculo fibularis brevis son usados ampliamente, especialmente como injertos de base distal, para cubrir defectos en la parte inferior de la pierna y el pie. El objetivo de este estudio fue analizar el suministro de sangre del músculo fibularis brevis y la base vascular de los posibles diferentes injertos. Para el estudio se utilizaron ambas piernas de 12 cadáveres preservados, sin anomalías vasculares congénitas. El músculo fibularis brevis fue encontrado en todas las piernas junto con los diferentes pedículos arteriales. Se calcularon las medias totales y las desviaciones estándar de la longitud y el ancho del músculo, junto con los diámetros de los vasos principales. La longitud y el ancho totales de la porción media del músculo fibularis brevis fueron de 28,7±0,4 cm y 3±0,02 cm, respectivamente. Las partes superior y media del músculo estaban suplidas vascularmente por la arteria fibular y la arteria tibial anterior. La parte media se complementó con la rama perforante superior de la arteria tibial posterior. La parte inferior del músculo fue suplida por una rama perforante inferior de la arteria tibial posterior y las arterias periósticas. El músculo podría usarse como un colgajo de base proximal o distal, injerto de músculo vascularizado libre, colgajo osteomuscular vascularizado libre y colgajo dividido distal. Se puede dividir por completo en dos colgajos; cada uno de estos puede ser utilizado como proximal o distal.

Reconstrucción con injerto autólogo no vascularizado de peroné posterior a resección de quiste óseo simple en segundo metatarsiano: a propósito de un caso / Reconstruction with non-vascularized autologous fibula graft after resection of simple bone cyst in the second metatarsal: a case report

El quiste óseo simple es una patología pseudotumoral características de las dos primeras décadas de la vida, localizada principalmente en húmero o fémur. La localización metatarsiana es considerada rara. El peroné puede ser utilizado para reconstrucción de defectos óseos. Se realizó estudio observacional, descriptivo, en el Hospital Dr. Adolfo Pons de Maracaibo, Edo Zulia, Venezuela, donde presentamos paciente femenino de 12 años de edad, en quien se reconstruyó defecto óseo metatarsiano producto de resección de quiste simple, mediante injerto no vascularizado de peroné. Se obtuvo consolidación e integración total de injerto con resultado funcional excelente(AU)

Simple bone cyst is a pseudotumoral condition that when coming up, it usually occurs during the first two decades of life, mainly located in the humerus or femur. The metatarsal location is considered rare. The fibula can be used for bone defects reconstruction. An observational and descriptive study was conducted at Dr. Adolfo Pons Hospital, in which we present a 12 years old patient who underwent a second metatarsal bone defect reconstruction with a non-vascularized fibular graft after resection of a simple cyst. Graft consolidation and total integration were obtained with excellent functional outcome(AU)

Resection of Thumb Metacarpal Ewing Sarcoma and Primary Reconstruction with Non-Vascularized Osteoarticular Metatarsal Autograft

Ewing sarcoma is a primary bone malignancy that rarely occurs in the hand. Resection and reconstruction will usually result in reduced or loss of thumb function. We describe a case of successful transplantation of nonvascularized osteoarticular second metatarsal autograft following wide resection of Ewing sarcoma of first metacarpal in an 11-year-old girl. The capsule of the graft’s metatarso-phalangeal joint was repaired to achieve mobility of the joint. This enabled preservation of thumb function by a relatively simple surgical technique. Detailed surgical procedures and excellence function after 2 years following surgery are described.

Injerto vascularizado de peroné en pseudoartrosis de tibia residual a osteomielitis / Vascularized free fibula graft in pseudarthrosis of the tibia by a chronic osteomyelitis

Las fracturas de la tibia son las más frecuentes dentro de los huesos largos y corresponden con el 24% de las fracturas abiertas, siendo los accidentes de tránsito responsables de 50%. Los defectos óseos son el resultado de lesiones en los miembros por trauma agudo severo con pérdida ósea. El uso del injerto vascularizado de peroné para defectos óseos severos en tibia y fémur tiene una tasa de éxito de 61% a 91%. Caso Clínico: Se trata de paciente masculino de 21 años de edad con antecedentes fractura de tibia y peroné derecho en 1/3 medio que presentó pseudoartrosis atrófica con defecto óseo de 1/3 medio de tibia; Se realizó cirugía reconstructiva con osteotomía de peroné de 20 cm sin comprometer su vascularización y se implanto dentro del canal endomedular de la tibia como injerto uniendo los extremos proximal y distal, realizando síntesis con tutor externo de doble barra, manteniendo la alineación de la tibia derecha en su plano anteroposterior y lateral. La consolidación ósea e integración del injerto de peroné en tibia se consiguió a los 5 meses, a los 8 meses se realizó retiro del tutor externo. El paciente presenta acortamiento residual de 7 cm, lo cual se compensa con uso de alza de miembro inferior derecho en el calzado. Se puede concluir que el injerto vascularizado de Peroné ipsilateral ofrece gran rango de seguridad en la oferta vascular a la zona receptora favoreciendo la osteointegración con la formación de una neo tibia que biomecanicamente ofrece excelentes resultados.

Fractures of the tibia are the most common in the long bones and correspond to 24% of open fractures, traffic accidents being responsible for 50%. Bone defects are the result of limb injuries with severe acute traumatic bone loss. The use of vascularized fibular grafting for severe bone defects in tibia and femur has a success rate of 61% to 91%. Clinical case: Male patient is 21 years old with a history of fracture in the mid-third right tibia and fibula who presented atrophic nonunion and bone defect, reconstructive surgery was performed using fibular osteotomy 20 cm without compromising its blood supply and is implanted within the intramedullary canal of the tibia as graft join in the proximal and distal ends, making synthesis with double-bar external fixator, maintaining alignment of the right tibia in the anteroposterior and lateral plane. Bone healing and integration of the fibula grafting was achieved at 5 months, at 8 months was external fixator removal, the patient has a residual shortening of 7 cm, which is compensated by use of the right leg up in footwear. It can be concluded that the ipsilateral peroneal vascularized graft offers wide range of security in the vascular supply to the recipient area, promoting the bone integration with the formation of a biomechanically neo tibia that provides excellent results.

Clinical Evaluation of the Graft Rejection after Penetrating Keratoplasty

In order to evaluate risk factors (sex, age, preoperative diagnoses, graft size, neovascularization of the recipient cornea, bilaterality, history of the previous graft failure, doner corneal preservation method, phakic status, glaucoma and enucleation time after death) influencing graft rejection, we reviewed 96 eyes underwent penetrating keratoplasty at the Chonnam University Hospital from May 1992 to December 1995, retrospectively. The rate of the graft rejection in penetrating keratoplasty was 34.3% (33 eyes). In detail, graft rejection occurred in 16 eyes(47%) among 34 vascularized corneas of recipient(R=18.0, P=0.000), 23 eyes(69.7%) among 33 vascularized orneas of donor side after operation (R=0.3, P=0.010), 5 eyes(35.7%) among 14 bilateral grafts, 4 eyes (57.1%) among 7 eyes having a history of graft failure, 6 eyes(40.0%) among 15 aphakic eyes(R=3.84, P=0.033), and 14 eyes among 32 eyes enucleated longer than 6 hours after death (R=10.1, P=0.002). In contrast, graft rejection occurred in 13 eyes (76.5%) among 17 postoperative glaucomatous eyes and in 20 eyes (25.3%) among 79 postoperative non-glaucomatous eyes, there was no statistically significant difference between two groups(P>0.05). These results suggest that neovascularzation of the either donor or recipient cornea, aphakic status of the recipient eyes, and enucleation time longer than 6 hours after death are high risk factors for graft rejection.