Vascularized Scapular Bone Grafting: Indications, Techniques, Clinical Outcomes, and Alternatives

Edward M. Reece; Rebecca C. O'Neill; Matthew J. Davis; Amjed Abu-Ghname; Alexander E. Ropper; Michael Bohl; David S. Xu; Sebastian J. Winocour

doi:10.1055/s-0041-1723833

Seminars in Plastic Surgery, Table of Contents

Semin Plast Surg 2021; 35(01): 025-030
DOI: 10.1055/s-0041-1723833

Review Article

Vascularized Scapular Bone Grafting: Indications, Techniques, Clinical Outcomes, and Alternatives

Edward M. Reece

¹Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

²Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas

,

Rebecca C. O'Neill

¹Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

,

Matthew J. Davis

¹Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

²Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas

,

Amjed Abu-Ghname

¹Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

²Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas

,

Alexander E. Ropper

³Department of Neurosurgery, Baylor College of Medicine, Houston, Texas

,

Michael Bohl

⁴Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona

,

David S. Xu

³Department of Neurosurgery, Baylor College of Medicine, Houston, Texas

,

Sebastian J. Winocour

¹Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

› Author Affiliations

Abstract

Spinal fusion can be challenging to obtain in patients with complex spinal pathology. Medial scapular vascularized bone grafts (S-VBGs) are a novel approach to supplement cervicothoracic arthrodesis in patients at high risk of failed spinal fusion. In this article, we discuss the benefits of using VBGs compared with both nonvascularized bone grafts and free vascularized bone flaps and the surgical technique, feasibility, and limitations specific to the S-VBG.

Keywords

vascularized bone graft - spinoplastic reconstruction - medial scapula graft - autograft - spinal fusion - pseudoarthrosis

Full Text

References

References
1 Menezes AH. Craniocervical fusions in children. J Neurosurg Pediatr 2012; 9 (06) 573-585
2 Reece EM, Vedantam A, Lee S. et al. Pedicled, vascularized occipital bone graft to supplement atlantoaxial arthrodesis for the treatment of pseudoarthrosis. J Clin Neurosci 2020; 74: 205-209
3 Shin AY, Dekutoski MB. The role of vascularized bone grafts in spine surgery. Orthop Clin North Am 2007; 38 (01) 61-72 , vi, vi.
4 Reece EM, Raghuram AC, Bartlett EL. et al. Vascularized iliac bone graft for complex closure during spinal deformity surgery. Plast Reconstr Surg Glob Open 2019; 7 (07) e2345
5 Singh K, Nandyala SV, Marquez-Lara A. et al. Clinical sequelae after rhBMP-2 use in a minimally invasive transforaminal lumbar interbody fusion. Spine J 2013; 13 (09) 1118-1125
6 Chang KY, Hsu WK. Spinal biologics in minimally invasive lumbar surgery. Minim Invasive Surg 2018; 2018: 5230350
7 Alimi M, Navarro-Ramirez R, Parikh K. et al. Radiographic and clinical outcome of silicate-substituted calcium phosphate (Si- CaP) ceramic bone graft in spinal fusion procedures. Clin Spine Surg 2017; 30 (06) E845-E852
8 Ackerman DB, Rose PS, Moran SL, Dekutoski MB, Bishop AT, Shin AY. The results of vascularized-free fibular grafts in complex spinal reconstruction. J Spinal Disord Tech 2011; 24 (03) 170-176
9 Davis JB, Taylor AN. Muscle pedicle bone grafts; experimental study. AMA Arch Surg 1952; 65 (02) 330-336
10 Shaffer JW, Davy DT, Field GA, Bensusan JS. Temporal analysis of vascularized and nonvascularized rib grafts in canine spine surgery. Spine 1989; 14 (07) 727-732
11 Shaffer JW, Davy DT, Field GA, Bensusan JS, Kellis GJ. The superiority of vascularized compared to nonvascularized rib grafts in spine surgery shown by biological and physical methods. Spine 1988; 13 (10) 1150-1154
12 Yelizarov VG, Minachenko VK, Gerasimov OR, Pshenisnov KP. Vascularized bone flaps for thoracolumbar spinal fusion. Ann Plast Surg 1993; 31 (06) 532-538
13 Raghuram A, Singh A, Chang DK, Nunez M, Reece EM. Bone grafts, bone substitutes, and orthobiologics: applications in plastic surgery. Semin Plast Surg 2019; 33 (03) 190-199
14 Bohl MA, Mooney MA, Catapano JS. et al. Pedicled vascularized bone grafts for posterior lumbosacral fusion: a cadaveric feasibility study and case report. Spine Deform 2018; 6 (05) 498-506
15 Bohl MA, Mooney MA, Catapano JS. et al. Pedicled vascularized bone grafts for posterior occipitocervical and cervicothoracic fusion: a cadaveric feasibility study. Oper Neurosurg (Hagerstown) 2018; 15 (03) 318-324
16 Padiolleau G, Marchand JB, Odri GA, Hamel A, Gouin F. Scapulo-humeral arthrodesis using a pedicled scapular pillar graft following resection of the proximal humerus. Orthop Traumatol Surg Res 2014; 100 (02) 177-181
17 Bohl MA, Almefty KK, Preul MC. et al. Vascularized spinous process graft rotated on a paraspinous muscle pedicle for lumbar fusion: technique description and early clinical experience. World Neurosurg 2018; 115: 186-192
18 Rose GK, Owen R, Sanderson JM. Transposition of rib with blood supply for the stabilization of a spinal kyphosis. J Bone Joint Surg 1975; 57: 112
19 Bohl MA, Hlubek RJ, Turner JD, Kakarla UK, Preul MC, Reece EM. Far-lateral vascularized rib graft for cervical and lumbar spinal arthrodesis: cadaveric technique description. Plast Reconstr Surg Glob Open 2019; 7 (04) e2131
20 Bohl MA, Hlubek RJ, Turner JD, Reece EM, Kakarla UK, Chang SW. Novel surgical treatment strategies for unstable lumbar osteodiscitis: a 3-patient case series. Oper Neurosurg (Hagerstown) 2018; 14 (06) 639-646
21 Bohl MA, Mooney MA, Catapano JS. et al. Pedicled vascularized clavicular graft for anterior cervical arthrodesis: cadaveric feasibility study, technique description, and case report. Spine 2017; 42 (21) E1266-E1271
22 Yadav P, Rajput R. Pedicled transfer of vascularized scapular bone graft to the humerus. Plast Reconstr Surg 2001; 107 (01) 140-142
23 Nthumba P, George S, Jami M, Nyoro P. Reconstruction of the distal humerus and elbow joint using a pedicled scapular flap: case report. J Hand Surg Am 2013; 38 (06) 1150-1154
24 Pinsolle V, Tessier R, Casoli V, Martin D, Baudet J. The pedicled vascularised scapular bone flap for proximal humerus reconstruction and short humeral stump lengthening. J Plast Reconstr Aesthet Surg 2007; 60 (09) 1019-1024
25 Amin SN, Ebeid WA. Shoulder reconstruction after tumor resection by pedicled scapular crest graft. Clin Orthop Relat Res 2002; (397) 133-142
26 El-Sherbiny M. Reconstruction of the proximal humerus after wide resection of tumors: comparison of three reconstructive options. J Egypt Natl Canc Inst 2008; 20 (04) 369-378
27 Reece EM, Davis MJ, Abu-Ghname A. et al. Vascularized bone grafts for spinal fusion-part 4: the scapula. Oper Neurosurg (Hagerstown) 2021.
28 Lewis SJ, Kulkarni AG, Rampersaud YR. et al. Posterior column reconstruction with autologous rib graft after en bloc tumor excision. Spine 2012; 37 (04) 346-350
29 Wilden JA, Moran SL, Dekutoski MB, Bishop AT, Shin AY. Results of vascularized rib grafts in complex spinal reconstruction. J Bone Joint Surg Am 2006; 88 (04) 832-839
30 Quiñones-Hinojosa A, Jun P, Jacobs R, Rosenberg WS, Weinstein PR. General principles in the medical and surgical management of spinal infections: a multidisciplinary approach. Neurosurg Focus 2004; 17 (06) E1
31 Tubbs RS, Wartmann CT, Louis Jr RG, Shoja MM, Cormier J, Loukas M. Use of the scapular spine in lumbar fusion procedures: cadaveric feasibility study. Laboratory investigation. J Neurosurg Spine 2007; 7 (05) 554-557