Vascularized Bone Grafts for Spinal Fusion—Part 4: The Scapula

Edward M Reece; Matthew J Davis; Amjed Abu-Ghname; Edward Chamata; Scott Holmes; Sebastian Winocour; Scott L Hansen; David S Xu; Michael A Bohl; Alexander E Ropper

doi:10.1093/ons/opab034

Vascularized Bone Grafts for Spinal Fusion—Part 4: The Scapula

Operative Neurosurgery ◽

10.1093/ons/opab034 ◽

2021 ◽

Vol 20 (5) ◽

pp. 508-512

Author(s):

Edward M Reece ◽

Matthew J Davis ◽

Amjed Abu-Ghname ◽

Edward Chamata ◽

Scott Holmes ◽

...

Keyword(s):

Operative Time ◽

Bone Grafts ◽

Technical Note ◽

Surgical Experience ◽

Structural Support ◽

Spinal Reconstruction ◽

Novel Approach ◽

Cadaver Studies ◽

Vascularized Bone

Abstract BACKGROUND Solid arthrodesis is the long-term goal of most spinal reconstruction surgeries. A multitube of biologics as well as autograft is commonly used to augment the bony fusion. Medial scapular vascularized bone grafts (S-VBGs) are a novel approach to supplement cervicothoracic arthrodesis in patients at high risk for failed fusion. OBJECTIVE To discuss the benefits of using a vascularized scapular graft, pedicled to the rhomboid minor, compared to both nonvascularized bone grafts and free vascularized bone grafts, as well as the surgical technique, feasibility, and nuances of the surgical experience with an S-VBG. METHODS The anatomic feasibility of this procedure has been established in cadaver studies. This technical note details the operative steps and presents the first surgery in which a vascularized scapular graft was used to supplement cervicothoracic arthrodesis. RESULTS A single patient with complex cervical deformity was successfully treated with this novel arthrodesis approach. CONCLUSION Vascularized scapula grafts, pedicled on the rhomboid minor, provides both structural support and a source of vascularized autograft to a cervicothoracic arthrodesis. It leverages the benefits of a free-flap bone with less operative time and morbidity.

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Long-term Follow-up of Vascularized Bone Grafts for the Reconstruction of Tibial Nonunion: Evaluation with Computed Tomographic Scanning

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-199206000-00004 ◽

1992 ◽

Vol 32 (6) ◽

pp. 693-697 ◽

Cited By ~ 27

Author(s):

KAZUO IKEDA ◽

KATSURO TOMITA ◽

FUMIO HASHIMOTO ◽

SEIJI MORIKAWA

Keyword(s):

Bone Grafts ◽

Computed Tomographic ◽

Long Term Follow Up ◽

Tibial Nonunion ◽

Vascularized Bone

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Bone Grafts for Scaphoid Nonunion: An Overview

Hand Surgery ◽

10.1142/s0218810415400043 ◽

2015 ◽

Vol 20 (02) ◽

pp. 222-227 ◽

Cited By ~ 11

Author(s):

Steven E.R. Hovius ◽

Tim de Jong

Keyword(s):

Surgical Treatment ◽

Bone Graft ◽

Bone Grafts ◽

Good Position ◽

Vascularized Bone Graft ◽

Scaphoid Nonunion ◽

Non Union ◽

Non Surgical Treatment ◽

Vascularized Bone

The scaphoid is the most common fractured bone in the wrist. Despite adequate non-surgical treatment, around 10% to 15% of these fractures will not heal. Untreated scaphoid non-union can cause a scaphoid non-union advance collapse (SNAC), this is a progressive deformity and can cause degenerative changes in the wrist. Surgery is focused on achieving consolidation, pain reduction and a good position of the scaphoid while preventing osteoarthritis in the long-term. Surgery consists of reduction and fixation of the scaphoid with a non-vascularized or vascularized bone graft. An overview of the most used vascularized and non-vascularized bone grafts and their indications are presented.

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Management of scaphoid nonunions with vascularized bone grafts from the distal radius: mid- to long-term follow-up

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-016-1867-7 ◽

2016 ◽

Vol 27 (1) ◽

pp. 33-39 ◽

Cited By ~ 10

Author(s):

Konstantinos N. Malizos ◽

Zoe Dailiana ◽

Sokratis Varitimidis ◽

Antonios Koutalos

Keyword(s):

Distal Radius ◽

Bone Grafts ◽

Long Term Follow Up ◽

Vascularized Bone

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Long-term results of free vascularized bone grafts in maxillofacial surgery

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/s1010-5182(96)80392-1 ◽

1996 ◽

Vol 24 ◽

pp. 81

Keyword(s):

Maxillofacial Surgery ◽

Bone Grafts ◽

Long Term Results ◽

Vascularized Bone

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Vascularized Bone Grafts in Spinal Reconstruction: An Overview of Nomenclature and Indications

Seminars in Plastic Surgery ◽

10.1055/s-0041-1726101 ◽

2021 ◽

Vol 35 (01) ◽

pp. 050-053

Author(s):

Anna J. Skochdopole ◽

Ryan D. Wagner ◽

Matthew J. Davis ◽

Sarth Raj ◽

Sebastian J. Winocour ◽

...

Keyword(s):

Surgical Techniques ◽

Reconstruction Algorithm ◽

Bone Grafts ◽

Separate Entity ◽

Recipient Site ◽

Spinal Reconstruction ◽

Feeding Vessels ◽

Microsurgical Techniques ◽

Reconstructive Algorithm ◽

Vascularized Bone

AbstractSeveral vascularized bone grafts (VBGs) have been introduced for reconstruction and augmenting fusion of the spine. The expanding use of VBGs in the field of spinoplastic reconstruction, however, has highlighted the need to clarify the nomenclature for bony reconstruction as well as establish the position of VBGs on the bony reconstructive algorithm. In the current literature, the terms “flap” and “graft” are often applied inconsistently when describing vascularized bone transfer. Such inconsistency creates barriers in communication between physicians, confusion in interpreting the existing studies, and difficulty in comparing surgical techniques. VBGs are defined as bone segments transferred on their corresponding muscular attachments without a named major feeding vessel. The bone is directly vascularized by the muscle attachments and unnamed periosteal feeding vessels. VBGs are best positioned as a separate entity in the bony reconstruction algorithm between nonvascularized bone grafts (N-VBGs) and bone flaps. VBGs offer numerous advantages as they supply fully vascularized bone to the recipient site without the microsurgical techniques or pedicle dissection required for raising bone flaps. Multiple VBGs have been introduced in recent years to optimize these benefits for spinoplastic reconstruction.

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Bifocal Distraction to Regenerate Segmental Mandibular Defects Using a Custom Made Device: A Report of Two Cases

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0030-1254382 ◽

2010 ◽

Vol 3 (2) ◽

pp. 97-104 ◽

Cited By ~ 4

Author(s):

Sriram Krishnan ◽

Ramkumar Subramaniam

Keyword(s):

Paradigm Shift ◽

Operative Time ◽

Donor Site ◽

Bone Grafts ◽

Donor Site Morbidity ◽

Custom Made ◽

Ablative Surgery ◽

Special Expertise ◽

Temporary Stabilization ◽

Vascularized Bone

Background and objective: Mandibular reconstruction following tumor ablative surgery had been a challenge. It has gone through days of temporary stabilization with k-wire, stainless steel reconstruction plate to avascularized and vascularized bone grafts with varying degree of success and failure. Reconstruction with vascularized bone grafts, though most definitive, requires special expertise, expensive equipment, and long operative time. It also produces donor site morbidity and requires a significant learning curve. With the development of transport distraction techniques there has been a paradigm shift from “reconstructive” to “regenerative” surgery. The objective of this study was to identify the feasibility of an internal device for reconstruction of extensive mandibular defects. Methods and material: This article is to highlight a process of attempted mandibular regeneration in two cases using an indigenously designed distractor device. In individuals with extensive post ablative mandibular defects who were unwilling to have a secondary surgical site or were medically unfit for a long reconstructive procedure, the distraction technique can be used to reconstruct the lost mandibular structures. Conclusion: A satisfactory amount of regenerate was achieved using a bifocal distraction osteogenesis technique for extensive defects of the mandible. The custom made device which was used for this purpose was moderately satisfactory and requires further evaluation and refinement.

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Free vascularized femoral condyle bone graft in treatment of tubular bone nonunions

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17116/vto201902119 ◽

2019 ◽

Vol 26 (2) ◽

pp. 19-23

Author(s):

I. O Golubev ◽

I. A Kukin ◽

M. V Merculov ◽

G. N Shiryaeva ◽

O. M Bushuev ◽

...

Keyword(s):

Bone Graft ◽

Femoral Condyle ◽

Bone Grafts ◽

Long Term Results ◽

Operation Technique ◽

Tubular Bone ◽

Vascularised Bone Graft ◽

Femoral Condyles ◽

Vascularized Bone

Vascularised bone graft from femoral condyles - are relatively new method in treatment of bone nonunions, small bone defects and loss of articular cartilage. In this article experience of using of vascularized bone grafts from medial and lateral femoral condyles, operation technique and clinical cases with long-term results were described. In conclusion, authors generated basic indications for free vascularized bone grafts from femoral condyles.

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Vascularized Scapular Bone Grafting: Indications, Techniques, Clinical Outcomes, and Alternatives

Seminars in Plastic Surgery ◽

10.1055/s-0041-1723833 ◽

2021 ◽

Vol 35 (01) ◽

pp. 025-030

Author(s):

Edward M. Reece ◽

Rebecca C. O'Neill ◽

Matthew J. Davis ◽

Amjed Abu-Ghname ◽

Alexander E. Ropper ◽

...

Keyword(s):

High Risk ◽

Surgical Technique ◽

Spinal Fusion ◽

Clinical Outcomes ◽

Bone Grafting ◽

Bone Grafts ◽

Novel Approach ◽

Vascularized Bone

AbstractSpinal fusion can be challenging to obtain in patients with complex spinal pathology. Medial scapular vascularized bone grafts (S-VBGs) are a novel approach to supplement cervicothoracic arthrodesis in patients at high risk of failed spinal fusion. In this article, we discuss the benefits of using VBGs compared with both nonvascularized bone grafts and free vascularized bone flaps and the surgical technique, feasibility, and limitations specific to the S-VBG.

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