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CC BY-NC-ND 4.0 · Revista Iberoamericana de Cirugía de la Mano 2020; 48(01): 042-052
DOI: 10.1055/s-0040-1712095
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Use of Vascularized Periosteal Flaps in Upper Extremity Pathology

Article in several languages: English | español
Sergi Barrera-Ochoa 
1  icatMA Hand and Microsurgery Unit, ICATME, Hospital Universitari Quiron-Dexeus, Barcelona, Spain
,
Sergi Alabau-Rodriguez 
1  icatMA Hand and Microsurgery Unit, ICATME, Hospital Universitari Quiron-Dexeus, Barcelona, Spain
,
Dorka Liburd 
1  icatMA Hand and Microsurgery Unit, ICATME, Hospital Universitari Quiron-Dexeus, Barcelona, Spain
,
Maria Victoria González
1  icatMA Hand and Microsurgery Unit, ICATME, Hospital Universitari Quiron-Dexeus, Barcelona, Spain
,
Xavier Mir-Bulló
1  icatMA Hand and Microsurgery Unit, ICATME, Hospital Universitari Quiron-Dexeus, Barcelona, Spain
,
Francisco Soldado 
2  Pediatric Orthopedics Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
3  Pediatric Surgery, Hand and Microsurgery, Hospital Vithas San Jose, Vitoria, Spain
› Author Affiliations
Further Information

Publication History

07 March 2020

16 March 2020

Publication Date:
29 May 2020 (online)

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Abstract

Massive bone defects represent a challenge in orthopedics. The structural and biological contribution of vascularized bone flaps has significantly improved their treatment. Similarly, free vascularized periosteal flaps (VPF) have been used to treat bone defects in children, with higher flexibility, adaptability to the recipient's bed and good osteogenic and osteoinductive capacity. However, these are complex techniques related to donor area morbidity. We have started anatomical and clinical studies on the application of pediculated VPF in recalcitrant massive defects to reduce this morbidity. This article summarizes the fundamental aspects of the surgical technique, the main anatomical findings from cadaveric dissections and the applicability of pediculated VPF to treat biologically unfavorable bone defects at the upper limb. The authors review the vascularized humeral periosteal flap (VHPF), the dorso-ulnar and volar-radial forearm periosteal flaps and the vascularized first metacarpal periosteal flap, all described in previous papers. As a novelty, the dorsal wrist and hand VPF (4-5 radial periosteal flap and dorsum of the second metacarpal bone periosteal flap) are presented. In addition, clinical cases with recent VPF applications in common upper limb conditions are described.

Keywords

vascularized periosteal flap - pediculated flap - periosteum - upper extremity - pseudoarthrosis - bone defect