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Bone loss reconstruction II: Periosteum transfer of vascularized fibula

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The periosteum is a membrane covering the bone (see section 1 of fractures / injuries). One of its functions is to make the shaft of the bone grow in thickness, and is also relevant in fracture repair. In children, periosteum is thicker and richer in stem cells on the inside layer, when compared to adults.

Periosteum transfer of a vascularized fibula(Figure 7A) is a technique described by Dr Soldado for the reconstruction of extremities in children (http://www.ncbi.nlm.nih.gov/pubmed/22411339).
The reconstruction technique consists of covering the bone allograft with vascularized periosteum, achieving a very fast integration (Figure 7B-D), much faster than with Capanna technique. Children will not have to use crutches or braces for life.

This technique, which combines vascularized periosteum with bone allograft is ideal for reconstruction of bone defects caused by tumors and trauma of the lower extremities.
 

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Figure 7A. Vascularized periosteal flap prior to implantation. Its inner surface is rich in stem cells, with great ability to form bone and revascularize.
 

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Figure 7B. Loss of a 12 cm segment of the femur, due to a traffic accident which led to an open fracture. This patient will be treated using Dr Soldado's technique.

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Figure 7C. Vascularized periosteal flap covering the femoral allograft, in order to revascularize it.
 

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Figure 7D. CT image showing full integration of the allograft in a very short period of time, thereby allowing the patient to perform a normal life.


Other bone flaps (iliac crest, scapula, etc.) may also be used to replace bone loss.

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