sartorius muscle pedicle bone flap transplantation

Transplantation with a pedicled bone flap is performed by taking the bone in the muscle attached to the bone, retaining the muscle attachment portion and periosteum of the graft bone, and nourishing the graft bone by relying on the blood supply of the muscle pedicle. The pedicled bone flap is transplanted to an adjacent fracture, bone defect or osteonecrosis area to promote bone healing. The application of pedicle bone grafting has a history of nearly one hundred years. At present, pedicled bone flap transplantation has been widely used in clinical practice. Transplantation with pedicled bone flaps can be divided into three types: 1 with a constant pedicle bone graft, which has a constant bone extraction site and a large amount of bone; the muscle pedicle consists of a constant muscle or muscle group. The free range of the pedicle is large. More commonly used femoral trochanter region femoral musculoskeletal flap, iliac sphincter musculoskeletal flap, humerus fascia lata musculoskeletal flap, clavicular sternocleidomastoid musculoskeletal flap, scapula trapezius musculoskeletal flap, rib cage Large musculoskeletal flap, iliac crest anterior musculoskeletal flap, The musculoskeletal flap with the shallower anatomical position can also be cut together with the skin and the subcutaneous tissue to form a composite flap. 2 with pedicle bone metastases, refers to the use of ipsilateral humerus or ulnar metastasis to repair the defect of the tibia or fibula, the muscle pedicle is wide, with well-known blood vessels inside. 3 with pedicle cortical bone graft, also known as cortical bone stripping, the method uses long limbs of the limbs. The bone removal site is designed as needed, but the bone volume is less. Due to the short pedicle, the transplant distance is limited. Transplantation with pedicled bone flap has the following characteristics: (1) The transplanted bone has nourishing blood vessels from the pedicle or a well-known blood vessel to supply blood. It is a live bone graft with strong anti-infective ability and fast bone healing. It is suitable for infectious bone defects and refractory. Treatment of pseudo-articular joints and ischemic necrosis of the bone; 2 in some donor areas, composite flaps can be made as needed to repair multiple tissue defects at one time; 3 this method is simple and reliable for bone graft free grafting; Due to the limitation of the length of the pedicle, it can only be applied locally. 5 When removing the bone flap, try to keep the muscles attached and the periosteum intact. The free pedicle should be carefully and bluntly separated to avoid using an electric knife. Do not excessively pull or twist the muscle pedicle during transplantation to avoid damage to the blood circulation of the valve. Treatment of diseases: femoral head necrosis femoral neck fracture Indication The sartorius muscle pedicle flap graft is suitable for the treatment of femoral neck fracture and femoral head necrosis, and is more suitable for hip fusion. This operation is better than the simple sartorius pedicle bone graft, and the blood circulation is better. Surgical procedure Incision The hip-anterior lateral Smith-Petersen incision, or the modified Smith-Petersen incision, was performed from the highest point of the iliac crest, along the iliac crest to the anterior superior iliac spine, and then turned to the base of the large trochanter. 2. Exposure and preparation of bone flaps Cut the skin, subcutaneous tissue and deep fascia, find the lateral femoral cutaneous nerve, and pull it to the inside to protect it. Separate the inner and outer edges of the sartorius tendon. In the anterior superior iliac spine, the inguinal ligament is cut off, along the inner and outer edges of the sartorius muscle and the rectus muscle, and the inner and outer humerus are peeled from the bottom to the top to ensure that the sartorius muscle and the rectus femoris are not damaged. The attachment of the shin bone. From the anterior segment of the iliac crest with the anterior superior and inferior iliac crests (5 ~ 6) cm × 2cm bone block, the bone flap is turned down to cut the rectus femoris reclining head, close to the joint capsule down the free muscle pedicle. 3. Disease treatment and bone flap transplantation Take hip fusion as an example. The joint capsule and the diseased synovium were removed, the hip joint was dislocated, the diseased tissue and residual cartilage were removed, and the joint was reset and maintained in the functional position. Starting from the upper acetabulum of the acetabulum, through the neck of the femoral head to the intertrochanteric line, make a bone groove across the joint corresponding to the bone flap. The bone flap is trimmed and embedded in the bone groove, and each end is fixed by a screw. Another bone is implanted into the space and around the joint. Place the drainage and suture the incision layer by layer.