David S Sparks1, Daniel B Saleh2, Warren M Rozen3, Dietmar W Hutmacher4, Michael A Schuetz5, Michael Wagels6. 1. Department of Plastic & Reconstructive Surgery, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Queensland, Australia; Southside Clinical Division, School of Medicine, University of Queensland, 199 Ipswich Rd, Woolloongabba, Queensland, Australia; Centre for Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Queensland, Australia. Electronic address: d.sparks@uq.edu.au. 2. Department of Plastic & Reconstructive Surgery, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Queensland, Australia; Department of Plastic and Reconstructive Surgery, Newcastle Hospitals, Newcastle, UK. 3. Department of Surgery, School of Clinical Science at Monash Health, Monash University, Monash Medical Centre, Block E / Level 5, 246 Clayton Road, Clayton, Victoria, Australia. 4. Centre for Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Queensland, Australia; ARC Centre for Additive Biomanufacturing, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Queensland, Australia. 5. Centre for Musculoskeletal Surgery (CMSC), University Clinic Charité, Humboldt University & Free University Berlin, Augustenburger Platz 1, D-13353, Berlin, Germany; Trauma Research Group, Institute of Health and Biomedical Innovation, QUT, 60 Musk Ave, Kelvin Grove, Queensland, Australia. 6. Department of Plastic & Reconstructive Surgery, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Queensland, Australia; Southside Clinical Division, School of Medicine, University of Queensland, 199 Ipswich Rd, Woolloongabba, Queensland, Australia.
Abstract
BACKGROUND: Since the description of the free fibula flap by Taylor in 1975, many flaps composed of bone have been described. This review documents the history of vascularised bone transfer and reflects on the current understanding of blood supply in an effort to define all clinically described osseous flaps. METHODS: A structured review of MEDLINE and Google Scholar was performed to identify all clinically described bone flaps in humans. Data regarding patterns of vascularity were collected where available from the anatomical literature. RESULTS: Vascularised bone transfer has evolved stepwise in concert with advances in reconstructive surgery techniques. This began with local flaps of the craniofacial skeleton in the late 19th century, followed by regional flaps such as the fibula flap for tibial reconstruction in the early 20th century. Prelaminated and pedicled myo-osseous flaps predominated until the advent of microsurgery and free tissue transfer in the 1960s and 1970s. Fifty-two different bone flaps were identified from 27 different bones. These flaps can be broadly classified into three types to reflect the pedicle: nutrient vessel (NV), penetrating periosteal vessel (PPV) and non-penetrating periosteal vessel (NPPV). NPPVs can be further classified according to the anatomical structure that serves as a conduit for the pedicle which may be direct-periosteal, musculoperiosteal or fascioperiosteal. DISCUSSION: The blood supply to bone is well described and is important to the reconstructive surgeon in the design of reliable vascularised bone suitable for transfer into defects requiring osseous replacement. Further study in this field could be directed at the implications of the pattern of bone flap vascularity on reconstructive outcomes, the changes in bone vascularity after osteotomy and the existence of "true" and "choke" anastomoses in cortical bone.
BACKGROUND: Since the description of the free fibula flap by Taylor in 1975, many flaps composed of bone have been described. This review documents the history of vascularised bone transfer and reflects on the current understanding of blood supply in an effort to define all clinically described osseous flaps. METHODS: A structured review of MEDLINE and Google Scholar was performed to identify all clinically described bone flaps in humans. Data regarding patterns of vascularity were collected where available from the anatomical literature. RESULTS: Vascularised bone transfer has evolved stepwise in concert with advances in reconstructive surgery techniques. This began with local flaps of the craniofacial skeleton in the late 19th century, followed by regional flaps such as the fibula flap for tibial reconstruction in the early 20th century. Prelaminated and pedicled myo-osseous flaps predominated until the advent of microsurgery and free tissue transfer in the 1960s and 1970s. Fifty-two different bone flaps were identified from 27 different bones. These flaps can be broadly classified into three types to reflect the pedicle: nutrient vessel (NV), penetrating periosteal vessel (PPV) and non-penetrating periosteal vessel (NPPV). NPPVs can be further classified according to the anatomical structure that serves as a conduit for the pedicle which may be direct-periosteal, musculoperiosteal or fascioperiosteal. DISCUSSION: The blood supply to bone is well described and is important to the reconstructive surgeon in the design of reliable vascularised bone suitable for transfer into defects requiring osseous replacement. Further study in this field could be directed at the implications of the pattern of bone flap vascularity on reconstructive outcomes, the changes in bone vascularity after osteotomy and the existence of "true" and "choke" anastomoses in cortical bone.
Authors: David S Sparks; Siamak Saifzadeh; Flavia Medeiros Savi; Constantin E Dlaska; Arne Berner; Jan Henkel; Johannes C Reichert; Martin Wullschleger; Jiongyu Ren; Amaia Cipitria; Jacqui A McGovern; Roland Steck; Michael Wagels; Maria Ann Woodruff; Michael A Schuetz; Dietmar W Hutmacher Journal: Nat Protoc Date: 2020-02-14 Impact factor: 13.491
Authors: Rene' D Largo; Maximilian G Burger; Oliver Harschnitz; Conny F Waschkies; Andrea Grosso; Celeste Scotti; Alexandre Kaempfen; Sinan Gueven; Gernot Jundt; Arnaud Scherberich; Dirk J Schaefer; Andrea Banfi; Nunzia Di Maggio Journal: Front Bioeng Biotechnol Date: 2020-07-03
Authors: Sarah M Moss; Monica Ortiz-Hernandez; Dmitry Levin; Chris A Richburg; Thomas Gerton; Madison Cook; Jeffrey J Houlton; Zain H Rizvi; Paul C Goodwin; Michael Golway; Beth Ripley; James B Hoying Journal: Front Bioeng Biotechnol Date: 2022-03-09
Authors: Michael Knitschke; Anna Katrin Baumgart; Christina Bäcker; Christian Adelung; Fritz Roller; Daniel Schmermund; Sebastian Böttger; Philipp Streckbein; Hans-Peter Howaldt; Sameh Attia Journal: Front Oncol Date: 2022-01-19 Impact factor: 6.244