Article
Anatomical Study of Periosteal Vascularization of the Forearm: Design of Periosteal Vascularized Flaps and Clinical Application
Search Medline for
Authors
-
Sergi Barrera-Ochoa
- ICATME, Hospital Quirón-Dexeus, Hospital Sant Joan de Deu, Barcelona, Spain
-
Gerardo Mendez-Sanchez
- ICATME, Hospital Quirón-Dexeus, Barcelona, Spain
-
David Campillo-Recio
- ICATME, Hospital Quirón-Dexeus, Barcelona, Spain
-
Alfonso Rodriguez-Baeza
- Universitat Autònoma Barcelona (UAB), Barcelona, Spain
-
Xavier Mir-Bullo
- ICATME, Hospital Quirón-Dexeus, Universitat Autònoma Barcelona (UAB), Barcelona, Spain
-
Jorge Knörr
- Hospital Sant Joan de Deu, Barcelona, Spain
-
Francisco Soldado
- Hospital Sant Joan de Deu, Barcelona, Spain
| Published: | February 6, 2020 |
|---|
Outline
Text
Objectives/Interrogation: Vascularized periosteal flaps (VPF) have been reported as very effective for treating complex bone non-union in pediatric patients with excellent results due to their osteogenic potential.
The objective of this study is to present a detailed anatomical description of the periosteal vascularization of the radius and the ulna and the design of vascularized periosteal flaps. In addition, we report here the clinical utility of the VPF in complex cases of forearm nonunion in children.
Methods: Ten latex-colored upper limbs from fresh human cadavers were used. Branches were dissected under 3x loupe magnification, noting the periosteal, muscular, and cutaneous branches arising from the radial (RA), ulnar (UA), anterior (AIA) and posterior interosseous (PIA) arteries for the radius and ulna. The size of the pre and post-dissection flaps and vascular pedicles length were measured.
Three patients under age 18 years with forearm nonunion, who underwent a VPF procedure without bone grafting, were included for this study at a mean follow-up of 26 months.
Results: The AIA Vascular Axis was used to rise the Volar-Radial VPF. An average of 16.2 periosteal branches were obtained, with an average distance of 6.6 mm between them being the average size of the VPF was 41.3 cm2 before the dissection and 32.4 cm2 after dissection. Average pedicle length of 16,1 cm.
The RA Vascular Axis was used to rise the Radial VPF. The mean of periosteal branches was 20.8 branches with a mean VPF pre-dissection size of 54.8 cm2 and 39.3 cm2 post-dissection. Average pedicle length of 20.2 cm.
IPA Vascular Axis was used to rise the Dorso-Ulnar VPF. An average of 12.8 periosteal branches were obtained, with the mean CVP size being 26.2 cm2 pre-dissection and 20.4 cm2 post-dissection with an average pedicle length of 12.6 cm.
The UA Vascular Axis was used to rise the Ulnar VPF. The mean was 10.2 periosteal branches with an average size of the pre-dissection CVP of 37.5 cm2 and 28.2 cm2 post-dissection and a pedicle of 14.8 cm.
There were two radius nonunions and a ulna nonunion. The mean bone defect was 18 mm. Successful consolidation was achieved in all cases.
Conclusions: we have described 4 new VPF. The most useful and versatile VPF were the Dorso-Ulnar VPF based on the PIA and the Volar-Radial VPF based on the AIA. The main advantages of these flaps comparing to microsurgery techniques, are the simplicity and short time of the technique, its elasticity and adaptability to the surgical site.
