Clinical research of vascularized fibular head epiphyseal transfer for Bayne and Klug type Ⅱ and Ⅲ congenital radial dysplasia
10.3760/cma.j.cn114453-20210629-00275
- VernacularTitle:胫前动脉返支为蒂游离腓骨头骺移植治疗Bayne-Klug Ⅱ、Ⅲ型先天性桡骨发育不良
- Author:
Chang LIU
1
;
Shanlin CHEN
;
Yunhao XUE
;
Pengcheng LI
;
Dedi TONG
;
Chen YANG
Author Information
1. 北京积水潭医院手外科 100035
- Keywords:
Congenital radial dysplasia;
Fibular head;
Bone transplantation;
Recurrent branch of anterior tibial artery
- From:
Chinese Journal of Plastic Surgery
2021;37(9):968-975
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical effect of free fibular head epiphysis transplantation pedicled with the recurrent branch of the anterior tibial artery in the treatment of children with Bayne-Klug Ⅱ-Ⅲ congenital radial dysplasia.Methods:From February 2013 to September 2018, we retrospectively reviewed and analyzed our prospective database of four patients with Bayne-Klug type Ⅱ-Ⅲ congenital radius dysplasia referred to Beijing Jishuitan Hospital for consideration of free fibular head epiphysis transplantation. All children underwent surgical treatment by stages: (1) Before surgery, the radial soft tissue and wrist joint were gradually stretched by massage and traction braced to maximize the radial space. (2) A free fibular head pedicled with the recurrent branch of the anterior tibial artery was harvested from the ipsilateral lower limb and transferred as a vascularized fibular head composite flap for reconstructing the stable structure of the distal radius and wrist joint. (3) At least six months after the procedure, pollicization was performed on Blauth type Ⅳ and Ⅴ. The treatment effect was evaluated by measuring the radial deviation angle, the growth length of the fibula, and the ratio of the radius/ulna length.Results:A total of 4 boys with right side deformity were enrolled. The ages of the patients ranged from 16 to 62 months, with an average of 30.5 months. The post-operative follow-up period was 19 to 78 months, with an average of 40.5 months. Three children with Blauth type Ⅳ or Ⅴ thumb dysplasia were performed with pollicization about one year after free fibular head epiphysis transplantation. All the grafted bones healed; the radial deviation angle was corrected by an average of 24°; the reconstructed distal radius grew longer, with an average increase of 13.2% when the plate was removed compared with six weeks post-operatively; the ratio of the radius/ulna was an average increase of 13.3% compared with preoperative.Conclusions:The use of fibular head epiphyseal flap pedicled with the recurrent branch of the anterior tibial artery is a good method for the treatment of Bayne-Klug type Ⅱ-Ⅲ radius dysplasia. The reconstructed distal radius has the ability to grow longitudinally, which can effectively correct the radial deviation and avoid the further development of the deformity.
