Soft-tissue reconstruction in orthopedic surgery. Secondary procedures.
The original consulting microsurgeon should be present to assist in the identification and protection of the vascular pedicle during secondary procedures on microvascular transplants. Flap elevation, trimming, and bone graft placement should be completed during a single tourniquet time, whenever possible. Flaps can easily be resutured on the original bed while the tourniquet is still inflated. Although proximal pedicle transection is possible, it should be avoided by careful planning, because the transplanted tissue cannot be predictably expected to survive, especially with muscle transplants. The distal muscle should be transected only in situations in which the muscle inset is extremely complex. Transection in the extramuscular portion of the main pedicle may require prompt microsurgical repair in immature muscle transplants. The safest approach is to avoid the pedicle whenever additional secondary procedures are necessary following free microvascular tissue transplantation. Placement of vascular pedicles such that the anterior crest of the tibia is avoided if the Ilizarov technique is required permit uncomplicated distraction osteosynthesis. Simultaneous Ilizarov fixation and microvascular tissue transfer are safe, practical procedures for limb salvage. Placement of the Ilizarov fixator at the time of microvascular transplantation provides stable fixation and eliminates the need for a subsequent anesthetic for fixator placement. This form of stabilization, when performed at the time of microvascular tissue transfer, allows the orthopedic surgeon direct visualization of the fracture site as the fixator is placed and eliminates the need for placement of the fixation device through the transplanted tissue. Tissue expansion or suction lipectomy are sometimes needed to optimize the clinical result.
Feibel
R J
RJ
Department of Surgery, University of Ottawa, Ottawa General Hospital, Ontario, Canada.
Oliva
A
A
Buncke
G M
GM
Jackson
R L
RL
Buncke
H J
HJ
D016025:Bone Transplantation / Q000379:methods; D006801:Humans; D015187:Lipectomy / Q000379:methods; D009132:Muscles / Q000637:transplantation; D009984:Orthopedic Fixation Devices; D013524:Surgical Flaps / Q000379:methods*; D015626:Tissue Expansion / Q000379:methods