Pediatric Hand Surgery and Microsurgery, Barcelona Children's Hospital, HM Nens, HM Hospitales, Barcelona, Spain.
Department of Plastic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Microsurgery. 2024 Sep;44(6):e31218. doi: 10.1002/micr.31218.
Pure vascularized periosteal transplants have been shown to be extremely effective at achieving rapid bone healing in children with biologically complex non-union. Free tibial and fibular periosteal transplants are generally indicated when large periosteal flaps are necessary. We report using a vascularized femoral myo-periosteal graft (VFMPG) to treat distal tibial osteotomy non-union in a six-year-old boy with congenital pseudarthrosis of the tibia. The graft consisted of a 9 cm myo-periosteal flap (after 50% of elastic retraction) that incorporated the vastus intermedius muscle and diaphyseal femoral periosteum nourished by the descending branch of the lateral circumflex femoral vessels. Plantaris medialis was used as a recipient vessel. Healing occurred 10 weeks after surgery. The patient resumed gait and sports activity without orthosis. No donor or recipient site complications occurred 17 months after surgery. Employing a VFMPG might be an alternative to other free or large vascularized periosteal flaps currently in use for complex pediatric non-unions.
单纯血管化骨膜移植已被证实对生物复杂性骨不连的儿童具有非常显著的快速骨愈合效果。游离胫骨和腓骨骨膜移植通常用于需要大骨膜瓣时。我们报告了使用带血管化股外侧肌骨膜骨瓣（VFMPG）治疗 6 岁男孩胫骨远端截骨骨不连，该男孩患有先天性胫骨假关节。该移植物由 9 cm 长的骨膜肌瓣（弹性回缩 50%后）组成，包含股中间肌和股骨干骺端骨膜，由旋股外侧动脉降支滋养。使用比目鱼肌作为受区血管。术后 10 周愈合。患者无需矫形器即可恢复行走和运动。术后 17 个月，无供区或受区并发症。与目前用于复杂儿童骨不连的其他游离或大血管化骨膜瓣相比，采用 VFMPG 可能是一种替代方法。
