Gevork V.Yaghjyan , Artavazd B. Sahakyan

CENTER OF PLASTIC AND RECONSTRUCTIVE SURGERY & MICROSURGERY
Yerevan, Armenia

INTRODUCTION.

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The treatment of patients with wide-spread defects of forearm bones of different etiology is a difficult task of Reconstructive Surgery. Transplantation of vascularized tissues with microsurgical techniques in combination with osteosynthesis apparatus of exterior fixation opens principally new possibilities in Reconstructive Surgery. In spite of effectiveness of the given method, according to the data of different authors, one of the frequent complications is a nonunion of one of the ends of bone transplant.

PURPOSE OF THE STUDY.

The given report is devoted to our experience of treatment of nonunion of one of the junctions of bone transplant, applied for substitution of bone defects of forearm.

MATERIALS AND METHODS.

In our Center from 1995 till 1997 ten patients (2 female and 8 male) with defects of forearm bones had treated. Age of the patients ranged 16-35 years. In 4 patients the defects appeared initially as a result of gunshot injuries, in 2 observations - as a result of prolonged conservative treatment of gunshot osteomyelitis, and in two cases - as a result of multifragmental fracture of forearm bones. Patients with defects of radial bone formed 60% of patients. Vascularized bone transplant was used in 8 patients, and only in 2 patients with small defects (till 4 cm) we substituted defects by distraction. Among 8 patients with carried out transplantation the nonunion of one of the ends of transplant were observed in the 4 patients (50%). Reoperations were carried out in terms from 6 to 18 months, after bone substitution. Depending on terms of conducting the operations the patients with nonunion were divided in two groups: the I group - two patients with terms of nonunion from 6 to 8 months, and the II group - two patients with terms of nonunion more than 8 months. The removal of interfragmental cicatricial tissue with end refreshment as well as with decorticating and subsequent osteosynthesis by means of the compression Ilizarov's apparatus were made in patients of the I group. Implantation into nonunion region the bone split from distal part of ulnar bone designed by island osseal flap on the posterior interosseous artery was used in patients of the II group. In 15 days' fixation by mans of Hoffman exterior fixation apparatus was carried out with the patients of the second group.

RESULTS.

The first symptoms of consolidation in patients of second group were recorded in terms till 2 months, whereas the same in patients of the first group were recorded in terms of 3,5 months after reoperation.

CONCLUSION.

The results allow to come to the conclusion that in the presence of symptoms of slowed-up consolidation repeated surgical intervention, revising of the of nonunion area with additional implantation of a bone split, with an autonomous blood flow (island flap with the split of ulnar bone) and a stable osteosynthesis brings to the acceleration of consolidation. Rotation arc of osseal flaps based on posterior interosseous vessels (on the anterograde and retrograde blood flow) allows to implantate the bone splits in nonunion areas within the range of ulnar and radial bones.