Article
Combination of two vascularized bone grafts for closing a huge defect of humerus. A case presentation
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Authors
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Uldis Krustins
- Microsurgery Centre of Latvia, Riga East University Hospital, Riga, Latvia
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Dzintars Ozols
- Microsurgery Centre of Latvia, Riga East University Hospital, Riga, Latvia
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Janis Zarins
- Microsurgery Centre of Latvia, Riga East University Hospital, Riga, Latvia
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Ervins Lavrinovics
- Microsurgery Centre of Latvia, Riga East University Hospital, Riga, Latvia
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Vadims Nefjodovs
- Microsurgery Centre of Latvia, Riga East University Hospital, Riga, Latvia
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: To demonstrate a rare case of combination of two vascularized bone grafts to save the upper arm of the young woman in a case of chronic osteomyelitis
Methods: Female, 26 y.o., right hand dominant, was presented in outpatient clinic with a deformation of the upper arm, full range of motion in the shoulder and wrist joints, limitation of elbow flexion 95 degrees and 40 degrees insuficiency of extension as well a 12 year history of haematogenous osteomyelitis of the humerus. During the childhood she underwent several surgical excisions of the inflammated bone and was administered to a peroral antibacterial therapy during the periods of the exacerbation of the disease. After the X-ray and MRI examination, head of the humerus and 2-3 cm of the proximal diaphysis, as well as distal 3 cm of the humerus were considered as healthy enough to be left for reconstruction.
Two different vascularized bone grafts - fibular as flow through graft and iliac crest were harvested to close the defect of the upper arm. The primary fixation of both bone grafts as well as vascular connections were performed on the oparation table outside the body. Later this complex bone graft was fixated with DePyu Synthes Long Philos plate in the proximal part of the humerus and cannulated 3.5 mm screws in combination of 1.5 mm Kirschner wires in the distal part. Bone grafts were wrapped into the previously prepared periosteal flap. Anastamoses of the complex bone graft were connected end to side to brachial artery and veins. Aftertreatment included 8 weeks of peroral antibibiotics and workout of ROM which started from the third week after surgery. Scheduled visits were performed every 2 months with measurements of the ROM and X-ray controls.
Results and Conclusions: Within a year after surgery patient is back to almost all daily and sporting activities, despite of the limitation of elbow flexion and visual differences of both upper arms. She has full extension and 110 degrees flexion of the elbow. The DASH score is 35 points. An active bone formation is presented between all fragments.
Non-standard decisions and technical solutions could be successful in microvascular bone flap surgery in cases of large osteomyelitic bone defects of the upper arm.
