Recipient bone (muscle, skin) transplantation

Bone defects caused by or after bone tumor resection; congenital sacral pseudoarthrosis, or pseudoarthrosis caused by nonunion of the fracture; various benign bone tumors or inflammatory lesions are left after the curettage, Bone grafting to restore the firmness of the bones; various internal and external fusion, limb lengthening, osteotomy, and poor blood flow in the fracture for open reduction, bone graft can fill the defect, promote healing, strengthen Fusion; congenital dislocation of the hip with acetabular capping or hip rotation; bone fractures, such as femoral neck fractures, or ischemic osteonecrosis, such as adult femoral head necrosis, feasible anastomotic Bone grafting, in place of hardening bone, increases local blood supply and promotes bone healing. Treatment of diseases: traumatic femoral head necrosis, hand trauma, head trauma Indication Bone defects caused by or after bone tumor resection. Congenital sacral pseudoarthrosis, or pseudoarthrosis caused by nonunion of the fracture. Various benign bone tumors or inflammatory lesions can be filled with cavities after scraping to restore bone firmness. Various joint internal and external fusion, limb lengthening, osteotomy or vertebral orthopedic surgery for fracture reduction, bone graft can fill the defect, promote healing and strengthen fusion. Congenital dislocation of the hip is performed by acetabular capping or hip rotation. Fractures with poor blood supply, such as femoral neck and intracapsular fractures, or ischemic osteonecrosis, such as adult femoral head necrosis, can be used to replace the bone graft of the blood vessel, instead of hardening the bone, increase local blood supply, and promote bone healing. Surgical procedure 1. Position: The patient's position should take into account both the donor and recipient areas, so that the donor and recipient areas can start surgery at the same time. If there is a contradiction, the donor area surgery should be taken first, and the position should be adjusted after the operation of the donor area is basically completed. 2. Incision: The incision is designed according to the need to cut the affected area and expose the receiving blood vessels (including arteries, accompanying veins and superficial veins such as agitation, veins and cephalic veins). For example, if an incision is difficult to balance the two, especially when the area is slightly infected, the incision is often used to expose the blood vessel, so that the vascular anastomosis can be performed in the clean incision to reduce the chance of infection. 3. Excision of diseased tissue: The general requirement is that the diseased tissue must be completely removed. (1) Scar tissue (including skin and soft tissue scars) should be completely removed so that the transplanted bone has a good blood supply bed. (2) If the bone is not connected after fracture, traumatic or inflammatory bone defect, the hardened bone end should be removed, and the bone marrow cavity should be cut through to form a new wound to facilitate healing. (3) For congenital sacral pseudoarthrosis, fibrous tissue and abnormal bone tissue at both ends and around the pseudoarticular joint should be removed. After resection, not only the two bone ends are normal bone tissue, but also the normal muscle and subcutaneous tissue. (4) When the tumor segment of low-grade malignant bone tumor is resected, the two ends should be at least 3 to 5 cm away from the tumor tissue, and bone marrow tissue sections should be taken during the operation to check whether the resection is complete. 4. Exposing the receiving blood vessels: the receiving vessels of the limbs generally use branches of the main arteries. For example, the branches of the radial artery include the deep iliac artery, the anterior and posterior iliac artery, the ulnar artery, the radial artery, etc., and the branch of the femoral artery has deep femoral artery. The inner and outer arteries, the radial artery, the anterior and posterior iliac arteries, etc. In addition to the accompanying veins, one or two superficial veins, such as the cephalic vein, the venous vein, the large and small saphenous veins and their branches should be prepared. According to the anatomical site, the blood vessel was exposed, and a section was separated under the operating microscope. The artery was not cut off. The artery was blocked by a microvascular clamp, the tourniquet was loosened, and the blood supply of the limb was observed. If there is no blood supply disorder, the artery can be cut off for end-to-end anastomosis; if there is a blood supply disorder, the artery can not be cut off, only for end-to-side anastomosis, or alternatively to receive blood vessels. In addition, it is necessary to pay attention to the outer diameter and length of the blood vessel, preferably close to the outer diameter of the graft vessel, and can be cut to a longer length to conform to the blood vessel. 5. Implantation of bone graft (periosteal): There must be internal fixation between the graft bone and the recipient bone, but the principle is simple and practical. Intramedullary nails are generally not used because they destroy the endoste. If the graft bone is smaller than the recipient bone, the graft bone can be inserted into the bone marrow cavity of the bone for about 2 cm, and then fixed with 2 screws. If the bone is similar to the size of the bone, each bone end can be sawed into an l shape, which is mutually aligned and fixed by two screws. It is also possible to embed one end and fix the other end in an l shape. Therefore, the length of the bone cut should be 4 to 5 cm longer than the actual defect. For the treatment of nonunion for periosteum transplantation, after the end of the bone is fixed, the periosteum is unfolded, wrapped around the fracture site, and the edge of the periosteum is fixed and sutured by the periosteum. For example, periosteum transplantation for the treatment of bone defects, can be embedded in the bone graft, or bone graft, or bone marrow bone graft, or first use the bone plate screw to fix the fracture end, the end of the fold is filled with cancellous bone, and then used The periosteum is wrapped and fixed by intermittent suture of the periosteum. 6. Vascular suture: After the bone or periosteum is fixed, the blood vessel can be sutured. If the incision is cleaned, the vascular suture can be performed in the original incision; if it is a contaminated incision, it is better to use another incision to expose the receiving blood vessel, and then the vascular pedicle of the transplanted bone is introduced into the cleaning incision through the subcutaneous tunnel to suture. The suturing method can cut off the blood vessel and make an end-to-end anastomosis with the vascular pedicle of the transplanted bone; if only one artery is supplied with blood in the receiving area, only the end side suture can be used. If there is a bone defect in the recipient area and there is a major arterial defect, the iliac bone graft should be used to repair the bone defect. At the same time, the iliac and vein are embedded between the defect vessels to restore blood flow. In the suture sequence, one vein is first sutured, one artery is sutured, and one vein is sutured. If the diameter of the accompanying vein is large or small, the small accompanying vein may not be sutured, because part of the blood can be recirculated through the medullary cavity. After the blood circulation is rebuilt, the muscles attached to the transplanted bone have active bleeding, venous filling, and reflux. Before the blood vessel is sutured, the graft vessel and the receiving vessel should be turned to the shallow part to be mutually aligned, and appropriately trimmed to make the length appropriate, and care should be taken to avoid distortion or sharp angle. 7. Stitching: After complete hemostasis, suture the incision layer by layer, paying attention to the vascular anastomosis must have muscle coverage. If the skin is defective, it can be transplanted with local flap or medium-thickness skin graft. In order to prevent the formation of hematoma, plastic sheet drainage or negative pressure drainage should be placed.