Reconstruction of oncologic tibial defects in children using vascularized fibula flaps.

Abstract:

BACKGROUND:Tibial resection in children presents a unique reconstructive challenge because of technical demands, future growth potential, and repetitive loading of the lower extremity. Positioned in a tibial defect, the free fibula undergoes primary bone healing while maintaining intrinsic resistance to infection and the ability to hypertrophy. The authors' aim was to evaluate surgical and functional outcomes in this selected group of pediatric patients. METHODS:This is a retrospective review of 13 consecutive pediatric oncology patients who underwent reconstruction of segmental tibial defects with intercalated vascularized fibula flaps from 1992 to 2007. Perioperative and long-term complications were noted. Functional outcomes were analyzed. RESULTS:Thirteen patients with a mean age of 12.6 years (range, 6 to 17 years) were included. Median follow-up was 63 months (range, 8 to 168 months). Overall survival was 77 percent. Flap survival was 100 percent. Perioperative local complication rate was 23 percent secondary to infection (two of 13 patients) and minor wound breakdown (one of 13 patients). Perioperative infection and chemotherapy did not significantly impact union or fracture rates. Hypertrophy of the fibula approached native tibial size in 90 percent of surviving patients. Median time to union was 10 months, average time to partial weight bearing was 5 months (range, 2 to 10 months), and time to full weight bearing was 16 months (range, 9 to 34 months). Of surviving patients, 91 percent achieved full weight bearing by 2 years, all of whom were ultimately able to participate in athletics. CONCLUSIONS:Functional reconstruction of segmental tibial defects in children can be achieved safely and reliably with the vascularized fibula. Infectious complications are low, but problems with union and fracture at this lower extremity site can be common until graft hypertrophy occurs. Those who achieve disease control may ultimately enjoy an active lifestyle. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, IV.

journal_name

Plast Reconstr Surg

authors

Schwarz GS,Disa JJ,Mehrara BJ,Healey JH,Cordeiro PG

doi

10.1097/PRS.0b013e318230e463

subject

Has Abstract

pub_date

2012-01-01 00:00:00

pages

195-206

issue

1

eissn

0032-1052

issn

1529-4242

pii

00006534-201201000-00035

journal_volume

129

pub_type

杂志文章
  • Aesthetic outcome of different techniques of reconstruction following nipple-areola-preserving envelope mastectomy with immediate reconstruction.

    abstract:BACKGROUND:Nipple-preserving mastectomy and immediate reconstruction has further improved the aesthetic outcome of skin-sparing mastectomy. To investigate the effect of the type of reconstruction technique on aesthetic outcome, three different methods of reconstruction were compared using four evaluation modalities. M...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/01.prs.0000251999.52374.09

    authors: Mosahebi A,Ramakrishnan V,Gittos M,Collier J

    更新日期:2007-03-01 00:00:00

  • Dermal suspension and parenchymal reshaping mastopexy after massive weight loss: statistical analysis with concomitant procedures from a prospective registry.

    abstract:BACKGROUND:An increasing number of women are presenting for mastopexy after massive weight loss. The authors analyzed data from a prospective registry of massive weight loss patients who underwent the dermal suspension and parenchymal reshaping mastopexy alone or with concomitant operations to assess safety and efficac...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/PRS.0b013e31819ba1a8

    authors: Rubin JP,Gusenoff JA,Coon D

    更新日期:2009-03-01 00:00:00

  • Gigantic lipomas.

    abstract::Two cases of unusually giant lipomas--weighting 5070 and 4000 gm--are described. Tumors were present for 5 years on the back in a 55-year-old man and for 20 years at the anterior compartment of the thigh in an 80-year-old woman. Difficulty in fitting clothes was the first patient's sole complaint, and social pressure ...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/00006534-199408000-00025

    authors: Hakim E,Kolander Y,Meller Y,Moses M,Sagi A

    更新日期:1994-08-01 00:00:00

  • A long-term retrospective outcome assessment of facial growth, secondary surgical need, and maxillary lateral incisor status in a surgical-orthodontic protocol for complete clefts.

    abstract::In 1965, the cleft palate team at Children's Memorial Hospital embarked on a new surgical-orthodontic protocol in the habilitation of newborn complete cleft lip and palate cases. It brought the orthodontic effort into focus at birth and in planned sequence to correspond with the surgical procedures of lip closure, max...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/01.PRS.0000037680.39989.74

    authors: Rosenstein SW,Grasseschi M,Dado DV

    更新日期:2003-01-01 00:00:00

  • Cystic lesions of the parotid gland.

    abstract::In a series of 708 parotidectomies (partial or total), we found 23 cystic lesions. Of these, 16 met the criteria for so-called "branchial cysts"; five were retention cysts of duct origin, and the remaining two were epidermal inclusion cysts. The principles of diagnosis and treatment of parotid cysts are presented. ...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/00006534-197803000-00009

    authors: Richardson GS,Clairmont AA,Erickson ER

    更新日期:1978-03-01 00:00:00

  • The surgical treatment of congenital webbing (pterygium) of the popliteal area.

    abstract::We describe a case of congenital popliteal pterygium in conjunction with other specific congenital malformations. This syndrome has been called the quadruple syndrome. The literature is reviewed. A rationale for more aggressive treatment of this deformity is discussed. One child who has undergone major multiple nerve ...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/00006534-197509000-00020

    authors: Tuerk D,Edgerton MT

    更新日期:1975-09-01 00:00:00

  • Decision-Making in Middle Vault Reconstruction following Dorsal Hump Reduction in Primary Rhinoplasty.

    abstract:BACKGROUND:Dorsal hump reduction during open rhinoplasty disrupts the continuity between the upper lateral cartilages and the dorsal septum. Options to reconstitute the midvault include primary closure of the upper lateral cartilages to the dorsal aspect of the septum, placement of spreader grafts, and creation of spre...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/PRS.0000000000006850

    authors: Avashia YJ,Marshall AP,Allori AC,Rohrich RJ,Marcus JR

    更新日期:2020-06-01 00:00:00

  • Examination of peripheral nerves with the scanning electron microscope.

    abstract::The theoretical applications and advantages of the scanning microscope in peripheral nerve research are presented. The internal anatomy of the peripheral nerve can be distinctly examined, and long segments of axons can be examined without the necessity of tedious study of multiple sections. The SEM should make it poss...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/00006534-197904000-00012

    authors: Van Beek AL,Jacobs SC,Zook EG

    更新日期:1979-04-01 00:00:00

  • A guide to organizing a multicenter clinical trial.

    abstract::Multicenter clinical trials are important research tools. Planning a multicenter clinical trial is a long and arduous task that requires substantial preparation time. In this guide, the authors discuss the steps used to plan a multicenter clinical trial. A preplanning phase, which involves formulating and refining a r...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章,评审

    doi:10.1097/PRS.0b013e3181df64fa

    authors: Chung KC,Song JW,WRIST Study Group.

    更新日期:2010-08-01 00:00:00

  • Critical Evaluation of Risk Factors and Early Complications in 564 Consecutive Two-Stage Implant-Based Breast Reconstructions Using Acellular Dermal Matrix at a Single Center.

    abstract:BACKGROUND:Acellular dermal matrix for implant-based breast reconstruction appears to cause higher early complication rates, but long-term outcomes are perceived to be superior. This dichotomy is the subject of considerable debate. The authors hypothesized that patient characteristics and operative variables would have...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/PRS.0000000000001327

    authors: Selber JC,Wren JH,Garvey PB,Zhang H,Erickson C,Clemens MW,Butler CE

    更新日期:2015-07-01 00:00:00

  • Factors contributing to the facial aging of identical twins.

    abstract:BACKGROUND:The purpose of this study was to identify the environmental factors that contribute to facial aging in identical twins. METHODS:During the Twins Day Festival in Twinsburg, Ohio, 186 pairs of identical twins completed a comprehensive questionnaire, and digital images were obtained. A panel reviewed the image...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/PRS.0b013e31819c4d42

    authors: Guyuron B,Rowe DJ,Weinfeld AB,Eshraghi Y,Fathi A,Iamphongsai S

    更新日期:2009-04-01 00:00:00

  • Infracture technique for reduction malarplasty with a short preauricular incision.

    abstract::The infracture technique for reduction malarplasty has been widely used as an aesthetic surgical procedure in northeast Asia. Since 1988, the authors' original method of infracture technique was performed through the combined approach of intraoral and temporopreauricular incision, which may leave a rather long scar on...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/01.prs.0000110217.60491.56

    authors: Yang DB,Chung JY

    更新日期:2004-04-01 00:00:00

  • A modification of the great-toe transfer for thumb reconstruction.

    abstract::A modification of the great-toe-to-thumb transfer is presented, which includes sculpting the transferred toe with removal of soft-tissue pulp and bone from the lateral side of the toe. This modification provides the aesthetic advantages of the wrap-around flap while avoiding problems of bone graft resorption, pulp mob...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/00006534-198809000-00033

    authors: Upton J,Mutimer K

    更新日期:1988-09-01 00:00:00

  • Comparison of trapeziectomy and trapeziectomy with ligament reconstruction and tendon interposition: a systematic literature review.

    abstract:BACKGROUND:Trapeziectomy with ligament reconstruction and tendon interposition is currently the most popular technique for operative treatment of trapeziometacarpal osteoarthritis. Based on the evidence, however, it is uncertain whether the addition of ligament reconstruction and tendon interposition to trapeziectomy c...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章,评审

    doi:10.1097/PRS.0b013e318217435a

    authors: Li YK,White C,Ignacy TA,Thoma A

    更新日期:2011-07-01 00:00:00

  • Breast reconstruction with myocutaneous flaps in previously irradiated patients.

    abstract::Breast reconstructions performed with latissimus dorsi and transverse rectus abdominis myocutaneous (TRAM) flaps in 82 patients with a history of previous chest-wall irradiation were compared with similar reconstructions in 202 nonirradiated patients to determine whether prior irradiation was associated with more freq...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:

    authors: Kroll SS,Schusterman MA,Reece GP,Miller MJ,Smith B

    更新日期:1994-03-01 00:00:00

  • The anatomic data sheet in plastic surgery: graphic and accurate documentation for standardized evaluation of results.

    abstract::A graphic and written anatomic data sheet (ADS) for facial aesthetic surgery and body contour surgery is presented as a tool for: (1) analyzing surgical maneuvers and their effect on final outcome; (2) recording individual anatomic variations; (3) communicating data between office personnel and colleagues; (4) aiding ...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/00006534-199304000-00030

    authors: Matarasso A

    更新日期:1993-04-01 00:00:00

  • Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant Cadaver Simulation: The Culmination of Aesthetic, Craniofacial, and Microsurgery Principles.

    abstract:BACKGROUND:The application of aesthetic, craniofacial, and microsurgical principles in the execution of face transplantation may improve outcomes. Optimal soft-tissue face transplantation can be achieved by incorporating subunit facial skeletal replacement and subsequent tissue resuspension. The purpose of this study w...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/PRS.0000000000002122

    authors: Sosin M,Ceradini DJ,Hazen A,Levine JP,Staffenberg DA,Saadeh PB,Flores RL,Brecht LE,Bernstein GL,Rodriguez ED

    更新日期:2016-05-01 00:00:00

  • The Efficacy of Breast Implant Irrigant Solutions: A Comparative Analysis Using an In Vitro Model.

    abstract:BACKGROUND:Infections are challenging complications of implant-based breast reconstruction and augmentation. They pose a clinical challenge, with significant economic implications. One proposed solution is implant irrigation at the time of placement. There is no consensus on the optimal irrigant solution. METHODS:The ...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/PRS.0000000000007028

    authors: Ngaage LM,Elegbede A,Brao K,Chopra K,Gowda AU,Nam AJ,Ernst RK,Shirtliff ME,Harro J,Rasko YM

    更新日期:2020-08-01 00:00:00

  • A prospective cohort study of fibula free flap donor-site morbidity in 157 consecutive patients.

    abstract:BACKGROUND:Although the fibula free flap is preferred for bony head and neck reconstruction, donor-site morbidity remains a concern. The authors' goal was to evaluate potential risk factors for complications and whether the type of wound closure and timing of postoperative ambulation had an effect on the development of...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/PRS.0b013e318221dc2a

    authors: Momoh AO,Yu P,Skoracki RJ,Liu S,Feng L,Hanasono MM

    更新日期:2011-09-01 00:00:00

  • Salvage of seeing eyes after avulsion of upper and lower lids.

    abstract::It is often stated that any injury severe enough to avulse both lids will inevitably destroy the globe. Two cases are presented in which the globe was uninjured but exposed, requiring immediate coverage. Local skin flaps placed over mobilized conjunctiva were used for emergency cover. One was eventually made into func...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/00006534-198501000-00003

    authors: Achauer BM,Menick FJ

    更新日期:1985-01-01 00:00:00

  • The clinical and diagnostic consequences of Poly Implant Prothèse silicone breast implants, recalled from the European market in 2010.

    abstract:BACKGROUND:Recently, Poly Implant Prothèse silicone breast implants were recalled from the European market. The authors studied 112 women and previously published data on rupture prevalence. Women are presenting with symptoms they feel may be a result of ruptured implants. The authors' aim was to study the clinical con...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/PRS.0b013e31827c70aa

    authors: Maijers MC,Niessen FB

    更新日期:2013-03-01 00:00:00

  • The increasing incidence of melanoma.

    abstract::A study of our hospital records has confirmed a striking increase in the number of melanoma cases. An examination of the New York State statistics demonstrates a 202 percent increase in the case rate from 1950 to 1971. The Connecticut statistics extending from 1935 to 1972 show an age-adjusted incidence rate increase ...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/00006534-197601000-00010

    authors: Cosman B,Heddle SB,Crikelair GF

    更新日期:1976-01-01 00:00:00

  • Mammaplasty combining vertical and transverse approaches through a vertical incision.

    abstract::An adjustable vertical marking is described for vertical mammaplasty in mild and moderate hypertrophy or ptosis of the breast. A vertical rectangular flap with the pedicle supported at the inframammary fold provides fullness for the upper or the lower pole of the breast. It is fixed over the pectoralis aponeurosis alo...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/01.PRS.0000100811.71958.A5

    authors: Abramo AC,Teixeira JC Jr,Galindo A

    更新日期:2004-02-01 00:00:00

  • Vascular delay improves latissimus dorsi muscle perfusion and muscle function for use in cardiomyoplasty.

    abstract::Ischemia of the distal portion of the latissimus dorsi muscle occurs in muscle transfer for cardiomyoplasty and reduces distal muscle contractility and thus the mechanical effectiveness of cardiomyoplasty. We hypothesized that muscle function would be improved by a vascular delay procedure that increases distal muscle...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/00006534-199704001-00020

    authors: Carroll SM,Heilman SJ,Stremel RW,Tobin GR,Barker JH

    更新日期:1997-04-01 00:00:00

  • Radiographic analysis of the midface of a stillborn infant with a unilateral cleft lip and palate.

    abstract::The midface of a full-term stillborn infant with a right complete unilateral cleft lip and palate was studied with plain-film radiography and tomography, xeroradiography, and computerized axial tomography. Gross skeletal and soft-tissue deficiencies on the cleft side were evident as compared to the noncleft side and i...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/00006534-198608000-00018

    authors: Dado DV,Kernahan DA

    更新日期:1986-08-01 00:00:00

  • Liposuction Aspirate Fluid Adipose-Derived Stem Cell Injection and Secondary Healing in Fingertip Injury: A Pilot Study.

    abstract:BACKGROUND:Although fingertip injuries account for a high proportion of trauma patients, the correct surgical approach is still debated. The authors compared the traditional conservative approach and a new treatment based on the injection of liposuction aspirate fluid. METHODS:Forty consecutive patients with a fingert...

    journal_title:Plastic and reconstructive surgery

    pub_type: 临床试验,杂志文章

    doi:10.1097/PRS.0000000000004506

    authors: Tarallo M,Fino P,Ribuffo D,Casella D,Toscani M,Spalvieri C,Lattanzi W,Di Taranto G

    更新日期:2018-07-01 00:00:00

  • A clinical study of end-to-end versus end-to-side techniques for microvascular anastomosis.

    abstract::The choice of microvascular anastomotic technique, end-to-end versus end-to-side, is still an item of debate. A review of the literature reveals no difference in patency rates in animal models where there is no size discrepancy. The available clinical evidence stems from Godina's early experience, proclaiming a higher...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/00006534-199704000-00029

    authors: Samaha FJ,Oliva A,Buncke GM,Buncke HJ,Siko PP

    更新日期:1997-04-01 00:00:00

  • Using the Patient Reported Outcomes Measurement Information System to Evaluate Psychosocial Functioning among Children with Craniofacial Anomalies.

    abstract:BACKGROUND:Children with craniofacial anomalies are at risk for social exclusion, bullying, and psychological symptoms, all of which are associated with poor developmental and health outcomes. The National Institutes of Health-developed Patient Reported Outcomes Measurement Information System instruments may be useful ...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/PRS.0000000000001269

    authors: Shapiro DN,Waljee J,Ranganathan K,Buchman S,Warschausky S

    更新日期:2015-06-01 00:00:00

  • Computed tomographic angiography in planning abdomen-based microsurgical breast reconstruction: a comparison with color duplex ultrasound.

    abstract:BACKGROUND:To plan abdominal perforator-based microsurgical breast reconstruction, duplex ultrasound is often employed to preoperatively identify the location of abdominal wall perforating vessels. Recently, several groups have published the use of computed tomography angiography for preoperative planning in perforator...

    journal_title:Plastic and reconstructive surgery

    pub_type: 临床试验,杂志文章

    doi:10.1097/PRS.0b013e3181c82d24

    authors: Scott JR,Liu D,Said H,Neligan PC,Mathes DW

    更新日期:2010-02-01 00:00:00

  • Dacryoscintigraph evaluation of the repaired lacrimal drainage system.

    abstract::We have used dacryoscintigraphy to study the efficiency of the lacrimal system following the repair of a divided lower canaliculus in 4 children. This test has been reliable in evaluating lacrimal function and suggests that a canaliculus can be repaired and splinted satisfactorily. Our experience with dacryoscintigrap...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章

    doi:10.1097/00006534-197609000-00016

    authors: Hoehn JG,Vitale P,Elliott RA Jr

    更新日期:1976-09-01 00:00:00