Comparison of the treatment results of humerus diaphysis post-traumatic false joints using vascularized bone grafts with and without a monitor skin flap: Retrospective cohort study

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Abstract

BACKGROUND: The use of the microvascular flap in reconstructive surgery of complicated nonunions of the diaphysis of the humerus is highly valuable. Flaps with compromised blood supply are possible in up to 10% of cases and often lead to the failure of vascularized reconstruction. The combined skin + bone graft is a simple, useful, and reliable option for flap vitality control with a high success rate.

OBJECTIVE: To compare microvascular grafting with versus without monitoring the skin flap.

MATERIALS AND METHODS: Forty-one microvascular grafting was performed from 2010 to 2017 in patients with humeral non-union and bone defects in the Department of Microsurgery and Trauma of the Hand of Priorov National Medical Research Center of Traumatology and Orthopedics. A combined skin bone flap was used in 23 (56%) patients, and in 18 (44%) patients, grafting was performed without monitoring the skin flap Computed tomography and X-ray imaging were used to monitor non-union healing. The use of a signal skin flap is an effective way to control blood flow in the graft and improves treatment results.

RESULTS: In the group without monitoring of the skin flap, non-union healing was documented in 14 (77%) cases. In the group with monitoring of the skin flap, nonunion healing occurred in 22 (96%) cases.

CONCLUSION: Monitoring the skin flap is an effective option to ensure microvascular flap blood supply control and improves the outcomes in humeral nonunion healing.

About the authors

Igor O. Golubev

Priorov National Medical Research Center of Traumatology and Orthopedics; Russian Peoples’ Friendship University

Email: iog305@mail.ru
ORCID iD: 0000-0002-1291-5094

MD, PhD, Dr. Sci. (Med.), Head of the department of microsurgery and hand injury

Russian Federation, 10, st. Priorova, 127299, Moscow; 6 Miklukho-Maklaya street, 117198 Moscow

Anna R. Sarukhanyan

Russian Peoples’ Friendship University

Email: annesr@mail.ru
ORCID iD: 0009-0009-8088-2309

traumatologist-orthopedist

Russian Federation, 6 Miklukho-Maklaya street, 117198 Moscow

M. V. Merkulov

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: hand-clinic@mail.ru
ORCID iD: 0009-0004-9362-3449

MD, Dr. Sci. (Med.), traumatologist-orthopedist

Russian Federation, 10, st. Priorova, 127299, Moscow

Oleg M. Bushuev

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: bushuev_oleg@mail.ru
ORCID iD: 0009-0002-0051-2666

MD, Cand. Sci. (Med.), traumatologist-orthopedist

Russian Federation, 10, st. Priorova, 127299, Moscow

Galina N. Shiryaeva

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: hand-clinic@mail.ru

MD, Cand. Sci. (Med.), traumatologist-orthopedist

Russian Federation, 10, st. Priorova, 127299, Moscow

Il'ya A. Kutepov

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: kutepov_cito@mail.ru
ORCID iD: 0009-0001-3802-2577

MD, Cand. Sci. (Med.), traumatologist-orthopedist

Russian Federation, 10, st. Priorova, 127299, Moscow

Vasiliy D. Kuznetzov

Priorov National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: Dr.kuznetsovvd@gmail.com
ORCID iD: 0000-0003-1745-8010

graduate student, traumatologist-orthopedist

Russian Federation, 10, st. Priorova, 127299, Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. Fibular bone combined flap.

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3. Fig. 2. Fusion in the blood-filled plasty group in patients with and without the use of a signal flap.

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4. Fig. 3. Radiographs of patient P., 42 years old. Diagnosis: «Pseudarthrosis of the left humerus diaphysis distal third. Condition after multiple surgical interventions» (indicated by arrows).

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5. Fig. 4. Patient P., 42 years old. Radiographs 6 months after surgery. Signs of consolidation are indicated by arrows.

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