Anastomotic iliac osteotomy

The blood supply of the tibia is abundant. The main nutritional arteries include the branch of the iliac artery, the deep branch of the superior gluteal artery, the deep circumflex artery, the superficial circumflex artery, and the ascending branch of the lateral femoral artery. Due to the pedicle length of the deep circumflex artery, it can reach 6~8cm, and the outer diameter is larger, up to 1.5~3.0mm, which is easy to expose. In addition, the deep circumflex artery is mainly supplied to the anterior part of the iliac crest and has musculocutaneous artery supply. The superficial skin of the humerus; therefore, the iliac bone graft or the tibial flap transplantation of the anastomosis of the blood vessels is often performed in the clinic. Generally, the size of the transplanted bone can reach 10×3.5cm2 on average; the size of the transplanted skin can reach 10×7cm230×15cm2. Because of the slight curvature of the humerus, the iliac bone graft with anastomosed blood vessels is most suitable for reconstructing the mandibular bone and repairing the large bone defect of the pelvis. It can also be used for long bone defects of the extremities. It is also used to treat avascular necrosis of the femoral head in early adults. Wait. Transplantation of the anastomosis of the iliac bone flap is often used in patients with both bone defects and skin defects, such as traumatic or cutaneous and skeletal defects caused by tumor resection. Treatment of diseases: bone defects Indication Anastomosed iliac bone graft is most suitable for reconstructing the mandibular bone and repairing the pelvis large bone defect. It can also be used for long bone defects of the extremities. It is also used to treat avascular necrosis of the femoral head in early adults. Transplantation of the anastomosis of the iliac bone flap is often used in patients with both bone defects and skin defects, such as traumatic or cutaneous and skeletal defects caused by tumor resection. Preoperative preparation 1. Prevention of wound infection is an important guarantee for the success of bone grafting. The anti-infective power of the graft bone is very weak. Once infected, the bone graft is soaked in the pus, necrosis will occur, and failure will occur. The precautionary measures are: the skin should be strictly prepared for the affected area and the donor area; the storage process of the stored bone must have strict sterility requirements; those with bone and soft tissue infection must be cured after 3 to 6 months of infection. Bone graft surgery, otherwise the surgery is easy to stimulate local latent bacteria, so that the infection recurs. Such patients should use antibiotics before surgery, and should use the anti-infective cancellous bone graft or the anastomotic bone graft. 2. The soft tissue around the bone area and the blood supply to the bone should be rich, and the growth force should be strong, so as to ensure the healing process of the bone graft. If the local skin and soft tissues have extensive scars, the blood supply will not be good, and the content after bone transplantation will increase, the skin will be difficult to suture, and infection will occur easily, forming a sinus. Therefore, the scar should be removed before surgery, and the flap should be transplanted to create conditions for the healing of the bone graft. 3. Many patients who need bone grafting have undergone multiple operations or long-term external fixation, resulting in muscle atrophy of the injured limb, decalcification of the bones, varying degrees of joint activity, poor blood circulation and low anti-infectiveness. The tissue growth ability is also poor. External fixation after an indispensable period of bone grafting will result in muscle atrophy and increased joint stiffness. Therefore, a period of functional exercise and physical therapy should be performed before surgery. For patients with non-displaced lower extremity fracture non-union or bone defect, functional exercise can be performed under the protection of stent or external fixation. 4. Preoperative x-ray film to understand the condition of the diseased bone, design the operation according to the condition (including the bone grafting part, the size of the bone graft and the bone grafting method). If the bone graft is to be anastomosed, the full length of the graft bone and the lateral x-ray film should be taken before surgery to select the site and length of the bone graft. 5. Before the bone graft of the anastomotic blood vessel, the ultrasonic artery should be used to detect the presence and blood flow of the main artery in the donor and recipient limbs in order to design the operation. Generally, the branches of the main arteries of the limbs are used for anastomosis, such as the deep femoral artery of the femoral artery, the inner and outer arteries of the circumflex femoral artery. If there are 2 main arteries in the receiving area, such as the ulnar artery, radial artery, anterior and posterior iliac artery, one of the main arteries may be used for anastomosis. The prerequisite must be that another major artery is confirmed by ultrasonic flowmeter or clinical examination. The blood supply is good. The veins in the recipient area are usually treated with superficial veins, such as the cephalic vein, the venous vein, the great crypt, the small saphenous vein and its branches. Therefore, the superficial vein of the recipient area should be examined for damage or inflammation before surgery. Recently used as a puncture, the superficial vein of the infusion cannot be used as a receiving vein. Surgical procedure 1. Position: The patient is lying on his back and the hips are raised. If the limb surgery requires a certain position, it can be adjusted appropriately. 2. Incision: The incision begins at the midpoint of the iliac crest, along the iliac crest to the anterior superior iliac spine, and then obliquely to the midpoint of the inguinal ligament, and squats 3 to 4 cm. 3. Exposing the blood vessels: After cutting the skin and subcutaneous tissue, the inguinal ligament is cut at the lower end of the incision, and the femoral artery and the external iliac artery are exposed in the femoral triangle. Carefully look for the deep circumflex artery from the outside of the femoral artery or outside the external iliac artery on the inguinal ligament. Here, the artery with the accompanying vein is found in the oblique anterior superior iliac spine, and the inferior epigastric artery is emitted at the corresponding site on the inner side of the external iliac artery. The artery can be determined as the deep circumflex artery. The transverse abdominis muscle and the intra-abdominal oblique muscle were dissected along the deep circumflex artery and gradually separated upwards to the medial aspect of the anterior superior iliac spine. The artery is divided into a terminal branch and a ascending branch near the anterior superior iliac spine; the ascending branch is advanced between the intra-abdominal oblique muscle and the transverse abdominis muscle, and the muscle of the anterior-lateral abdominal wall is supplied. Ligation and cutting of the ascending branch at the branch and continuing to separate the final branch. In general, the end of the anterior superior iliac spine. The artery is divided into a terminal branch and a ascending branch near the anterior superior iliac spine; the ascending branch is advanced between the intra-abdominal oblique muscle and the transverse abdominis muscle, and the muscle of the anterior-lateral abdominal wall is supplied. Ligation and cutting of the ascending branch at the branch and continuing to separate the final branch. In general, the posterior branch of the anterior superior iliac spine, between the fascia and the diaphragm, curved along the medial edge of the iliac crest, about 3 to 5 cm behind the anterior superior iliac spine into the transverse abdominis, in the abdomen The oblique muscle and the transverse abdominis muscles are backwards and arcs, and finally the anastomosis of the radial artery. During the walking of the final branch along the medial edge of the ankle, many small branches are separated to supply muscle and tibia. 4. Cut the humerus: design the size of the graft bone according to the needs of the receiving area. First along the lateral edge of the ankle, the gluteal muscle and the tensor fascia lata are cut and pulled open to reveal the lateral periosteum of the anterior tibial. 2cm away from the medial edge of the iliac crest, the intra-abdominal oblique muscle and the transverse abdominis muscle were cut from the anterior and posterior medial edges, so that about 2cm thick muscle was attached to the iliac crest to protect the sacral deep motion and vein. After the length of the sputum separation is sufficient, the transverse fascia is incised and the extraperitoneal fat and peritoneum are pushed inward. After the peritoneum is protected with a gauze pad, the deep pull hook is pulled to the inner side, and the gluteal muscle is pulled open by the hook to reveal the inner side and the outer side of the sputum, and the bone piece is cut from the outer side of the tibia with the bone knife. When cutting the bone block, the force should not be too large, so as to prevent the bone knife from entering the pelvic cavity. The humerus is gradually cut off to form a humeral bone pedicle with a deep circumflex artery. For example, the medullary cavity, periosteum and attached muscles of the bone have active bleeding, indicating good blood supply. 5. If the tibia is simply cut, in general, there is no difficulty in suturing the incision directly; if there is difficulty, a medium-thickness skin graft should be performed. The inguinal ligament should be reconstructed before suturing the incision.

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