The Journal of Bone and Joint Surgery, Vol 64, Issue 1 73-87, Copyright © 1982 by Journal of Bone and Joint Surgery, Inc
Microvascular free bone transfer with revascularization of the medullary and periosteal circulation or the periosteal circulation alone. A comparative experimental study
A Berggren, AJ Weiland, LT Ostrup and H Dorfman
Two different types of vascularized rib grafts presently are used in
clinical practice and as experimental models for investigations on free
microvascular bone transfer: the posterior rib graft, including both
medullary and periosteal blood supply to the bone; and the posterolateral
segmental rib graft, supplied by periosteal vessels alone, Complete
survival of bone after successful revascularization of the posterior type
of graft is well established, but this graft has the disadvantage of a
complicated dorsal dissection which has limited its clinical use. Instead,
many microsurgeons have utilized the posterolateral rib segment, which is
easy and safe to excise although its viability and adequate
microcirculation have not yet been confirmed. In nine large dogs, we
compared the viability and vascularity of bone after transfer of the two
types of bone grafts by histological methods, fluorochrome bone-labeling,
microangiography, and technetium scintigraphy. The grafts were transferred
to the subcutaneous fat tissue in the groin, where blood supply was
reconstituted by microvascular anastomoses to local donor vessels. The
results suggest that a bone transplant with revascularization of periosteal
only established a collateral circulation to medullary vessels, and that
there is no difference in viability of the two kinds of grafts. Clinical
Relevance: The technique of transferring whole bone segments by
microvascular anastomoses of their vascular pedicles has been employed
clinically either by preserving the periosteal blood supply alone or by
preserving the medullary and the periosteal blood supply. This study
demonstrates that the preservation of the periosteal blood supply alone can
result in complete bone-graft survival even when the graft is placed in a
poorly vascularized tissue bed.
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