Iliac pedicle wedge graft as a new modification for iliac. Osteonecrosis femoral head treatment by core decompression and iliac cresttfl muscle pedicle grafting 109 effectively. Anconeus musclepedicle bone graft with periosteal coverage. Tensor fascia lataemuscle pedicle bone grafting for a. Bone grafting technique for thoracolumbar pedicle screw. Bleeding from the raw surface of the muscle pedicle bone graft is observed. It may be mentioned, as a curiosity, that phelps 21, in 1891, was the first to transplant a musclepediele bone graft from a dog to an aided by a grant from the danish science foundation. Some authors propose here the combined use of a bone graft with isolation of the graft in a wellvascularised environment. The muscle pedicle covered more than half the periosteal surface. Being a vascularized graft, it is likely to unite with the recipient acetabular floor like an ordinary undisplaced fracture. The pedicle bone graft was transplanted within the limit of the blood supply of its muscle pedicle and without disturbing the periosteal attachment of the muscle to the bone. There was a higher incidence 87% of good quality of osseous fusion on the left side, where the sacrospinalis muscle pedicle bone graft was used, compared to the right, where 70% of fusions were satisfactory.
The base of the thumb metacarpal was present, the abductor insertion was present and there was still some thenar muscle mass present. Free vascularized bone and muscle flaps for osteomyelitis. Transpedicular bone grafting and pedicle screw fixation in. Sinocutaneous fistula repair with a masseter muscle. The wound bed and muscle flap are then infiltrated with bone marrow aspirate and platelet rich plasma. The end of the muscle bone pedicle graft was formed by a small piece of trochanter major. Jun 22, 2001 we treated 20 patients with symptomatic l45 isthmic spondylolisthesis ten grade i, nine grade ii and one grade iii surgically. Singlestage osteosynthesis and augmented muscle pedicle bone. Osteonecrosis of the femoral head was gradually concerned as a global disease for its progression to collapse of the femoral head, ultimately causing the arthritic change. Growth and transplantation of a custom vascularised bone. This method includes several surgical techniques including detachment of bone block with attachment of a portion of muscle called gluteus medius from the ilium of pelvis, curettage of dead bone from the femoral head through a window made in the femoral neck. Duhamel p, mathieu l, brachet m, compere s, rigal s, bey e. Quadratus femoris and gluteus medius muscles in which the bone block was detached from the proximal femur and sartorius and tensor fascia lata muscle in which the bone block was detached from the ilium.
This is not always an option, as the constraint that there must be sufficient tissue immediately lateral to the area of interest is an. Under direct vision the bone graft is then placed between. If the muscle pedicle was of sufficient width, not too long, and not stretched or twisted, the cut surface of the attached bone graft continued to bleed. Pdf download for anterior greater trochanteric muscle pedicle. It may be mentioned, as a curiosity, that phelps 21, in 1891, was the first to transplant a muscle pediele bone graft from a dog to an aided by a grant from the danish science foundation. Fig 5 the bone graft easily reaches the lunate and scaphoid. Vascularized pedicle iliac bone grafts, as a hippreserving surgery, were regarded as an. They are technically less demanding than are free vbgs and are associated with less morbidity. Osteonecrosis femoral head treatment by core decompression. The bone with attached muscle is released from the surrounding muscle fibers. To prevent creation of a donorsite bone defect, the patient was selected for the bonemuscleflap prefabrication technique. The exposed gluteus minimus muscle is erased from the outer surface of the ilium and retracted down. The lateral head of the muscle, compared to the medial, is used more rarely in. The present report is a case of fibrous dysplasia of the proximal femur with pathological fracture neck of femur treated by singlestage surgery of curettage, internal fixation, nonvascularized fibular grafting and tensor fascia lataebased muscle pedicle bone grafting.
Decompression was added in patients with radiculopathy. In 87% hips, a tensor fascia femoris graft was done in grade 2 and grade 3 avn with anterior and superior involvement. Sartorius muscle pedicle bone graft for the revascularization of the necrosed femur head is relatively unknown technique in the literature and has only been studied by li et al. Locations of the fracturing were 16 transcervical and 10 subcapital table. Complications in posterior pedicle screw fixation using a conventional posterior approach for thoracolumbar fractures include vertebral height loss, kyphosis relapse and breakage, or loosening of instrumentation.
Vascularized iliac bone graft for displaced femoral neck. On the right side, a muscle pedicle, consisting mainly of the m. Augmented osteosynthesis with tensor fascia latae muscle. Results there were no significant main effects of time p0. Original article clinical observation of mobile window. This ensures that the instrumentation does not block effective placement of the bone graft material in the lateral gutter. A muscle pedicle permitted to remain attached to autogenous bone grafts in rabbits was effective. Acetabular reconstruction by muscle pedicle bone graft for. Sartorius muscle pedicle was used in grade 1 avn 8%. Gluteus medius muscle pedicle bone grafting for treatment of.
The purpose of this study was to evaluate the clinical effects of transpedicular bone grafting and pedicle screw fixation in injured vertebrae using a paraspinal approach for. A total of 25 patients were treated using the anterior moving window muscle approach modified group, while 16 patients were treated. In the course of time, clinical attempts at employing musclepedicle bone grafts have in fact been made. Pedicle flap definition of pedicle flap by medical dictionary. The upper and posterior origins of vastus lateralis aredetached andretracted forwards downwards. The revascularisation process was quicker in the case of the pure muscle pedicle grafts, and it was delayed in muscle bone pedicle grafts, which can be explained by the morphological differences between the two forms.
Sartorius muscle pedicle bone graft technique allows adequate decompression, re vascularization and osteogenesis of the femur head in ficats stage iia. Lumbar pedicle screw fixation with cortical bone trajectory. In 1962, the autogenous muscle pedicle graft based on the quadratus femoris muscle was used for the first time. Vascularised bone grafting on a musclepedicle such as gluteus medius, quadratusfemoris, or sartoriusis an established method of treatment6,8.
Integra bilayer wound matrix is placed on top of the muscle flap. Advantages over non vascularized bone graft have been established. Open reduction and internal fixation with muscle pedicle grafting was. Participants anthropometry and blood bone metabolism markers were measured at pre and posttests. Internal fixation and muscle pedicle bone grafting in femoral. Muscle pedicle graft in avascular necrosis femoral head research.
Results of pronator quadratus pedicle bone graft as primary. The graft was rotated in order to provide a soft muscular padding to the femoral head, instead of the abrasive bony surface of an unrotated muscle pedicle bone graft or free graft. A total of 180 patients 199 hips with early nontraumatic onfh received surgical treatment by sartorius musclepedicle bone flap graft smbf 104 patients, 64 males and 40 females. A lateral pedicle graft, or pedicle graft, takes tissue from the area immediately adjacent to the damaged gingiva. Pedicle graft is inserted at the osteotomy site and fixed using pins. Judet 9 tried quadratus femoris muscle pedicle bone graft in dogs and later used the same technique in human beings. There have been several methods of muscle pedicle bone grafting. Instrumentation using transpedicular screws and rods in addition to posterolateral fusion was done in. The subepithelial connective tissue graft is a very common procedure for covering exposed roots. We treated 20 patients with symptomatic l45 isthmic spondylolisthesis ten grade i, nine grade ii and one grade iii surgically.
Us6418935b1 gluteus medius muscle pedicle bone grafting for. This term is preferred over transplant in the case of skin grafts. Peroneus brevis muscle flap with the use of integra wound. Fifty patients were randomly allocated in two groups containing 25 in each. Deepithelialized flaps and grafts have been widely used by reconstructive surgeons in a diverse array of surgical specialties and have more recently made an appearance in dermatologic surgery. Transplantation of pedicle bone grafts to fresh skeletal.
We present analysis of our 32 cases of displaced femoral neck fracture. We included 40 cases 53 hips of avn of femoral head operated with sartorius muscle pedicle iliac bone grafting, done by the senior author. Modified sacrospinalis muscle pedicle bone graft for fusion. The results in 11 48% patients were excellent, 9 39% were good, 2 9% fair and one 4% poor. Fig 6 periosteal branches red points of the anterior interosseous artery are found proximal to its division yellow. Internal fixation and muscle pedicle bone grafting in femoral neck. Meyers muscle pedicle graft has been used in delayed presentation and non union of neck femur fracture in adults with good results. Aug 28, 2004 to prevent creation of a donorsite bone defect, the patient was selected for the bone muscle flap prefabrication technique. Modified sacrospinalis musclepedicle bone graft 1 was done in nine patients of group 1.
In our study we used a tensor fascia latae muscle pedicle graft with intact. Pdf modified sacrospinalis muscle pedicle bone graft for. Musclepedicle grafts or musclepediclebone grafts in the treatment. Vascularized pedicle iliac bone grafts as a hippreserving. Placement of muscle pedicle bone graft acted as a viable vascular inlay graft, encouraging osteosynthesis and revascularization of the femoral head. Sacrospinalis musclepedicle bone graft in posterolateral. Ideally, in a lumbar fusion, the bone graft is placed posterolaterally after making the pedicle screw tracks but prior to actually placing the lumbar screws. Comparison of sartorius musclepedicle and circumflex iliac. Pdf sartorius muscle pedicle iliac bone graft for the treatment of. Sartorius muscle pedicle iliac bone graft for the treatment of avascular necrosis of femur head article pdf available april 2016 with 626 reads how we measure reads.
Pedicle bone graft provide improved blood flow, osteocyte preservation, and accelerated healing rates. So my doc ordered a 3 phase bone scan which it zeroed into the pedicle screws and talks about l3l4l5s1 uptake from minimal to mild to intense uptake from screws to plates i do not understand all this i. In those hips with a posterior quadrant involvement, a quadratus femoris muscle. In44patients aquadratus femoris musclepedicle bone graft including asegment ofthe intertrochanteric crest and theadjacent bone was used. We present analysis of our 32 cases of displaced femoral neck fracture treated by internal fixation and quadratus femoris based muscle pedicle bone grafting. Cheilectomy, drilling, curettage and tfl muscle pedicle bone. Sartorius muscle pedicle bone graft technique allows adequate decompression, re vascularization and osteogenesis of the. The mean time interval from injury to surgery was 3.
Primary closure with integra wound matrix and split thickness skin graft. Bilateral posterolateral fusion using the sacrospinalis muscle as a muscle pedicle bone graft was carried out in all patients. Local pedicle vbgs are the most commonly used methods. The revascularisation process was quicker in the case of the pure musclepedicle grafts, and it was delayed in musclebonepedicle grafts, which can be explained by the. The flap is widely applied to cover defects of the knee, the proximal tibia and femur 9. Asplit thickness skin graft is then applied on top of the integra wound matrix and secured with. The muscle pedicle bone graft was rotated and placed posteriorly over the fracture site and pegged into the trough created in the head and fixed with two 4mm cannulated cancellous screw in posterior to anterior direction tablefig3a,b. Musclepedicle grafts or musclepediclebone grafts in the.
Kohlman modification of vascularised muscle pedicle graft procedure, one underwent excision of a fragment in the proximal pole and the other underwent proximal row carpectomy of the waist of the scaphoid. Reconstruction of the achilles tendon with a composite anterolateral thigh free flap with vascularized fascia lata. Fractures involved the right side in 16 and the left side in 10. After extensive debridement including bone, and devitalized muscle and tendon tissue fig. Pdf sartorius muscle pedicle iliac bone graft for the. In44patients aquadratus femoris muscle pedicle bone graft including asegment ofthe intertrochanteric crest and theadjacent bone was used. Shortterm results of musclepedicle bone grafting with tensor. Anterior greater trochanteric muscle pedicle bone grafting. The latissimus dorsi and the pectoralis major flaps provide a great portion of muscle with a skin palette. The same width of anconeus muscle is elevated as a distalbased pedicle with approximately 1 cm of excess periosteum. In order to obtain a more dependable osteogenetic action, therefore, it seemed natural to apply a bone graft which had preserved its blood supply and viability. Internal fixation and muscle pedicle bone grafting in. Muscle pedicle graft in grade 1 and grade 2 avn femoral head does benefit the patient.
Several authors have used the quadratus femoris muscle based bone graft in the. Shortterm results of musclepedicle bone grafting with tensor fascia lata for delayed femoral neck fractures. Pdf shortterm results of musclepedicle bone grafting with. Pedicle graft definition of pedicle graft by medical dictionary. The end of the musclebonepedicle graft was formed by a small piece of trochanter major. In the course of time, clinical attempts at employing muscle pedicle bone grafts have in fact been made. The aim was to grow a subtotal replacement mandible inside the latissimus muscle with full bony continuity and an adequate vessel pedicle to allow for subsequent transplantation of a viable graft into the defect. This repair consisted of a commercial wound matrix dressing placed directly over the hole in the maxilla and secured with suture material. All patients complained of low back pain and nine had additional radicular pain. Obliteration of mastoid avity with temporalis muscle pedicle.
Meyers muscle pedicle bone graft a novel procedure in. Pedicle screws problems i finally had a low back mri which it did not show much but it was from that i had 4 injections that did not help. Muscle pedicle bone grafting has been advocated to provide additional blood supply. Sartorius muscle pedicle iliac bone graft for the treatment.
These techniques may be advantageous in their enabling of contour preservation of deep defects, reconstructions in areas of high mechanical tension, singlestage repairs, auricle reconstruction requiring. Sartorius muscle pedicle iliac bone graft for the treatment of. Due to the high incidence of this disease in young people, arthroplasty tends to be suspected for its uncertain longterm efficiency. Fig 4 bone graft harvested from the ulnar border of the distal radius and pedicled on the radial carpal artery. A method to treat a disease called osteonecrosis of the femoral head which is caused by interruption of blood supply to the femoral head. In this study, we found that sartorius muscle pedicle bone graft is an effective and easy surgery to perform. Meyers muscle pedicle bone graft a novel procedure in treatment.