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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2022; 07(02): e27-e34
DOI: 10.1055/s-0042-1757320
Original Article

Early Radiographic Outcomes of Vascularized Pedicle Bone Grafting in Foot: A Case Series

Francesca R. Coxe
1   Department of Hand Surgery, Hospital for Special Surgery, New York, New York
,
Eric A. Bogner
2   Department of Radiology, Hospital for Special Surgery, New York, New York
,
Margaret E. Cooke
3   Department of Hand Surgery, Stanford Medicine, Stanford, California
,
Martin J. O'Malley
4   Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York
,
Scott J. Ellis
4   Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York
,
Duretti T. Fufa
1   Department of Hand Surgery, Hospital for Special Surgery, New York, New York
› Author Affiliations Funding One author (D.T.F.) declares grants and personal fees from Medartis and personal fees from Integra. S.J.E, reports other from Paragon 28, other from Wright Medical, other from Vilex, outside the submitted work.
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Abstract

Background Navicular nonunion and talar avascular necrosis may result from limited blood supply predisposing to injury and impaired healing. Vascularized pedicled bone grafting is a promising adjunct to treat these challenging conditions, offering the susceptible diseased site structural and vascular support. We report the early radiographic and clinical outcomes of vascularized pedicled bone grafting in patients with navicular nonunion, talonavicular fusion nonunion, and talar avascular necrosis.

Methods Patients with navicular nonunion, talonavicular fusion nonunion, or talar avascular necrosis who underwent vascularized pedicled bone grafting at our institution from January 2014 to February 2019 were retrospectively identified. Radiographic evidence of healing was monitored postoperatively as defined by: progression toward union on CT for nonunion and absence of disease progression on MRI or CT for avascular necrosis. Surgical complications and need for additional surgeries were documented.

Results Eight patients were included who underwent vascularized pedicled bone grafting for navicular nonunion (N = 5), talonavicular fusion nonunion (N = 1), and talar avascular necrosis (N = 2). Average clinical follow-up was 10.8 months (range 4–37). All patients had 4 or more months postoperative radiographic follow-up with MRI or CT. Seven of eight patients demonstrated evidence of radiographic healing. One patient required additional surgery due to external fixator pin site infection. No other complications were reported.

Conclusion Our results corroborate prior case series suggesting vascularized pedicled bone grafting is a safe and reliable procedure for treating navicular nonunion, talonavicular fusion nonunion, or talar avascular necrosis with potential to spare or delay need for salvage procedures in the younger patient population.

Level of Evidence The evidence level is Level V.

Keywords

navicular - nonunion - talus - necrosis - pedicle - graft


Publication History

Received: 24 November 2021

Accepted: 29 May 2022

Article published online:
08 November 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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