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Treatment of Nonunion of Radius Bone with Vascularized Femural Corticoperiosteal Free Flap

January 01, 2013

Contributors: Antonini Andrea, MD; Antonio Vadala, MD; Daniele Paravani, MD; Domined= Cristina, MD; Andrea Ferretti, MD; Matteo Guzzini, MD; Matteo Guzzini, MD

Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.
Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.
Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.

The authors report a case of a 65-year-old woman with pseudoarthrosis of the right side radius bone. Her treatment involved two groups of surgeons. The first group treated her with a free vascularized corticoperiosteal graft harvested from the medial femoral condyle. A medial approach to the femur was performed, and the descending genicular artery (DGA) was found just proximal to the medial femoral condyle. After the DGA's isolation and the ligation of its collateral branches, the corticoperiosteal graft was freed with a circular osteotomy. Meanwhile, a second group of surgeons located the radial artery of the right forearm, isolated it and located and closed its collateral branches. The graft was then removed from the femoral area, and the DGA peduncle with two venae comitantes was cut. After reduction and fixation of the radial pseudoarthrosis, the graft was wrapped around the pseudoarthrosis and fixed with two screws. For the microsurgical portion of the operation, we performed a termino-terminal anastomosis of the DGA to the radial artery and another termino-terminal anastomosis between the two venae comitantes. With the aim of perfusing the corticoperiosteal graft, the first anastomosis was completed with an adventitiectomy of the two arteries and a small operculum on the radial artery where the DGA was sutured with an 8-0 wire. To provide venous drainage, the second anastomosis was also completed with a termino-terminal venous suture with 8-0 wire. Consequently, the vascularized graft had all the potential biological benefits to promote reparative osteogenesis by its vascularized periosteum. We did not report either perioperative or postoperative complications. The patient began walking with full weightbearing 2 days after surgery. At the 6-month follow-up, her radiographs indicated healing with the onset of bone callus at the level of the pseudoarthrosis. At the 7-month follow-up, she showed a complete recovery of range of motion of the elbow in flexion and extension. In conclusion, this surgical procedure seems to be a valid option for patients who would otherwise have a traditional non-vascularized graft for the treatment of pseudoarthrosis.

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