All patients complained of low back pain and nine had additional radicular pain. The mean time interval from injury to surgery was 3. 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 the course of time, clinical attempts at employing muscle pedicle bone grafts have in fact been made. In44patients aquadratus femoris musclepedicle bone graft including asegment ofthe intertrochanteric crest and theadjacent bone was used. Fig 4 bone graft harvested from the ulnar border of the distal radius and pedicled on the radial carpal artery. Musclepedicle grafts or musclepediclebone grafts in the. Singlestage osteosynthesis and augmented muscle pedicle bone.
The latissimus dorsi and the pectoralis major flaps provide a great portion of muscle with a skin palette. Fig 5 the bone graft easily reaches the lunate and scaphoid. Pdf sartorius muscle pedicle iliac bone graft for the. Flaps with an axial vascular pedicle are very reliable for reconstruction in irradiated situations. Pdf shortterm results of musclepedicle bone grafting with. After extensive debridement including bone, and devitalized muscle and tendon tissue fig. Judet 9 tried quadratus femoris muscle pedicle bone graft in dogs and later used the same technique in human beings. This repair consisted of a commercial wound matrix dressing placed directly over the hole in the maxilla and secured with suture material. Lumbar pedicle screw fixation with cortical bone trajectory. Pdf download for anterior greater trochanteric muscle pedicle. Vascularized pedicle iliac bone grafts as a hippreserving. 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. 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.
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. Comparison of sartorius musclepedicle and circumflex iliac. Placement of muscle pedicle bone graft acted as a viable vascular inlay graft, encouraging osteosynthesis and revascularization of the femoral head. In44patients aquadratus femoris muscle pedicle bone graft including asegment ofthe intertrochanteric crest and theadjacent bone was used. Fractures involved the right side in 16 and the left side in 10. 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. Muscle pedicle graft in avascular necrosis femoral head research. Sartorius muscle pedicle iliac bone graft for the treatment. 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. In those hips with a posterior quadrant involvement, a quadratus femoris muscle. A lateral pedicle graft, or pedicle graft, takes tissue from the area immediately adjacent to the damaged gingiva.
The width of the harvested bone graft is the crater diameter divided by the square root of 2 eg, graft width is approximately 9 mm for a lesion mm in diameter figure 2. Bleeding from the raw surface of the muscle pedicle bone graft is observed. 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. Obliteration of mastoid avity with temporalis muscle pedicle.
Modified sacrospinalis musclepedicle bone graft 1 was done in nine patients of group 1. Instrumentation using transpedicular screws and rods in addition to posterolateral fusion was done in. Fig 6 periosteal branches red points of the anterior interosseous artery are found proximal to its division yellow. Asplit thickness skin graft is then applied on top of the integra wound matrix and secured with. Local pedicle vbgs are the most commonly used methods. Participants anthropometry and blood bone metabolism markers were measured at pre and posttests. 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. Due to the high incidence of this disease in young people, arthroplasty tends to be suspected for its uncertain longterm efficiency. Pdf modified sacrospinalis muscle pedicle bone graft for.
Pdf sartorius muscle pedicle iliac bone graft for the treatment of. Gluteus medius muscle pedicle bone grafting for treatment of. Pedicle graft is inserted at the osteotomy site and fixed using pins. Muscle pedicle graft in grade 1 and grade 2 avn femoral head does benefit the patient. Modified sacrospinalis muscle pedicle bone graft for fusion. Results there were no significant main effects of time p0. This ensures that the instrumentation does not block effective placement of the bone graft material in the lateral gutter. Fifty patients were randomly allocated in two groups containing 25 in each. 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. 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. Tensor fascia lataemuscle pedicle bone grafting for a.
The subepithelial connective tissue graft is a very common procedure for covering exposed roots. Growth and transplantation of a custom vascularised bone. Original article clinical observation of mobile window. Cheilectomy, drilling, curettage and tfl muscle pedicle bone. In the course of time, clinical attempts at employing musclepedicle bone grafts have in fact been made. Sinocutaneous fistula repair with a masseter muscle.
Several authors have used the quadratus femoris muscle based bone graft in the. The bone with attached muscle is released from the surrounding muscle fibers. 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. The same width of anconeus muscle is elevated as a distalbased pedicle with approximately 1 cm of excess periosteum. 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. Musclepedicle grafts or musclepediclebone grafts in the treatment.
Sartorius muscle pedicle was used in grade 1 avn 8%. Being a vascularized graft, it is likely to unite with the recipient acetabular floor like an ordinary undisplaced fracture. The upper and posterior origins of vastus lateralis aredetached andretracted forwards downwards. The lateral head of the muscle, compared to the medial, is used more rarely in. 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. Open reduction and internal fixation with muscle pedicle grafting was.
Osteonecrosis femoral head treatment by core decompression. Acetabular reconstruction by muscle pedicle bone graft for. Bone grafting technique for thoracolumbar pedicle screw. 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. Muscle pedicle bone grafting has been advocated to provide additional blood supply. In 1962, the autogenous muscle pedicle graft based on the quadratus femoris muscle was used for the first time. We treated 20 patients with symptomatic l45 isthmic spondylolisthesis ten grade i, nine grade ii and one grade iii surgically. Peroneus brevis muscle flap with the use of integra wound. The exposed gluteus minimus muscle is erased from the outer surface of the ilium and retracted down. 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.
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. They are technically less demanding than are free vbgs and are associated with less morbidity. Internal fixation and muscle pedicle bone grafting in femoral. In this study, we found that sartorius muscle pedicle bone graft is an effective and easy surgery to perform. 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. Anconeus musclepedicle bone graft with periosteal coverage. Aug 28, 2004 to prevent creation of a donorsite bone defect, the patient was selected for the bone muscle flap prefabrication technique. Transpedicular bone grafting and pedicle screw fixation in. Sartorius muscle pedicle iliac bone graft for the treatment of. Vascularized pedicle iliac bone grafts, as a hippreserving surgery, were regarded as an. 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. 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.
The muscle pedicle covered more than half the periosteal surface. Anterior greater trochanteric muscle pedicle bone grafting. The flap is widely applied to cover defects of the knee, the proximal tibia and femur 9. 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. Jun 22, 2001 we treated 20 patients with symptomatic l45 isthmic spondylolisthesis ten grade i, nine grade ii and one grade iii surgically. To prevent creation of a donorsite bone defect, the patient was selected for the bonemuscleflap prefabrication technique. The end of the muscle bone pedicle graft was formed by a small piece of trochanter major. 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. 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. Sartorius muscle pedicle bone graft technique allows adequate decompression, re vascularization and osteogenesis of the. 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. Iliac pedicle wedge graft as a new modification for iliac. Meyers muscle pedicle bone graft a novel procedure in treatment. Pedicle flap definition of pedicle flap by medical dictionary.
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. Pedicle graft definition of pedicle graft by medical dictionary. Meyers muscle pedicle bone graft a novel procedure in. Sacrospinalis musclepedicle bone graft in posterolateral. Shortterm results of musclepedicle bone grafting with tensor. A muscle pedicle permitted to remain attached to autogenous bone grafts in rabbits was effective.
Primary closure with integra wound matrix and split thickness skin graft. The results in 11 48% patients were excellent, 9 39% were good, 2 9% fair and one 4% poor. The end of the musclebonepedicle graft was formed by a small piece of trochanter major. Internal fixation and muscle pedicle bone grafting in femoral neck.
Pedicle bone graft provide improved blood flow, osteocyte preservation, and accelerated healing rates. Locations of the fracturing were 16 transcervical and 10 subcapital table. The wound bed and muscle flap are then infiltrated with bone marrow aspirate and platelet rich plasma. In group a mastoid obliteration was done with pedicle temporalis muscle and with abdominal fat graft in group. Advantages over non vascularized bone graft have been established. 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. Vascularised bone grafting on a musclepedicle such as gluteus medius, quadratusfemoris, or sartoriusis an established method of treatment6,8. We included 40 cases 53 hips of avn of femoral head operated with sartorius muscle pedicle iliac bone grafting, done by the senior author. Internal fixation and muscle pedicle bone grafting in. Under direct vision the bone graft is then placed between. Osteonecrosis femoral head treatment by core decompression and iliac cresttfl muscle pedicle grafting 109 effectively. Decompression was added in patients with radiculopathy. We present analysis of our 32 cases of displaced femoral neck fracture treated by internal fixation and quadratus femoris based muscle pedicle bone grafting.
We present analysis of our 32 cases of displaced femoral neck fracture. Augmented osteosynthesis with tensor fascia latae muscle. Us6418935b1 gluteus medius muscle pedicle bone grafting for. Transplantation of pedicle bone grafts to fresh skeletal. On the right side, a muscle pedicle, consisting mainly of the m. Free vascularized bone and muscle flaps for osteomyelitis. 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. In 87% hips, a tensor fascia femoris graft was done in grade 2 and grade 3 avn with anterior and superior involvement. The tfl muscle pedicle graft by using part of ilia c crest described in this article is easy to perform and does not require any special equipment or technique, and still has the advantages of increased vascularity like vascula rised bone graft fig 1a1h. This term is preferred over transplant in the case of skin grafts. A total of 25 patients were treated using the anterior moving window muscle approach modified group, while 16 patients were treated.
Results of pronator quadratus pedicle bone graft as primary. Some authors propose here the combined use of a bone graft with isolation of the graft in a wellvascularised environment. This is not always an option, as the constraint that there must be sufficient tissue immediately lateral to the area of interest is an. 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. Bilateral posterolateral fusion using the sacrospinalis muscle as a muscle pedicle bone graft was carried out in all patients. Duhamel p, mathieu l, brachet m, compere s, rigal s, bey e. There have been several methods of muscle pedicle bone grafting. Reconstruction of the achilles tendon with a composite anterolateral thigh free flap with vascularized fascia lata. Vascularized iliac bone graft for displaced femoral neck. Shortterm results of musclepedicle bone grafting with tensor fascia lata for delayed femoral neck fractures. In our study we used a tensor fascia latae muscle pedicle graft with intact.