Anastomotic radial periosteum excision

Since Finley (1978) and other reports of anastomotic vascular periosteal transplantation test, it has been gradually applied in clinical practice. All parts of the bone graft that can be anastomosed, such as the humerus, ribs, and tibia, can form a periosteal graft that is pedicled with nutrient vessels. In addition, there have been reports of periosteum periosteum and tibial periosteum transplantation. In general, periosteal grafts for anastomotic vessels are used for nonunion and bone defects, and pedicled or islandal periosteal flaps have been reported for the treatment of nonunion or old fractures such as wrist and scaphoid fractures. Treatment of diseases: scaphoid fracture Indication All parts of the bone graft that can be anastomosed, such as the humerus, ribs, and tibia, can form a periosteal graft that is pedicled with nutrient vessels. In addition, there have been reports of periosteum periosteum and tibial periosteum transplantation. In general, periosteal grafts for anastomotic vessels are used for nonunion and bone defects, and pedicled or islandal periosteal flaps have been reported for the treatment of nonunion or old fractures such as wrist and scaphoid fractures. 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, the limb is abducted, and placed on a small table next to the operating table. 2. Incision: A longitudinal incision is made on the lateral side of the distal end of the forearm, which is about 5-6 cm long. 3. Expose the blood vessels: After cutting the skin, subcutaneous tissue and fascia, separate from the volar and dorsal sides, find the axillary and vein on the volar side, and cut the tendon tendon (repair after surgery). Carefully separate the spurs and veins. In the anterior muscle plane, a group of thicker nutrient vessels can be seen, which surround the humerus and go to the dorsal side to supply the dorsal periosteum of the tibia. 4. Obstruction of the periosteum: According to the needs of the receiving area, the periosteum including the nutrient vessels is cut, and the nutrient vessels are connected with the agitation and vein. The periosteum was carefully peeled off with a bone knife, and the periosteum was provided with a thin layer of bone to form a periosteal flap pedicled with agitation and vein. After the operation of the affected area is completed, it is determined that the length of the vascular pedicle is required, the iliac crest is cut, the vein is transferred, and the periosteal flap is transferred to the receiving area.

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