Name of the Procedure:

Bone Graft with Microvascular Anastomosis; other than Fibula, Iliac Crest, or Metatarsal

Summary

A bone graft with microvascular anastomosis is a surgical procedure where a piece of bone from one part of the body is transplanted to another site, with the critical addition of connecting blood vessels to ensure the graft’s viability. This specific type excludes the common donor sites such as the fibula, iliac crest, or metatarsal, utilizing alternative bones instead.

Purpose

This procedure is typically performed to repair or reconstruct bones that are missing due to trauma, tumor removal, or congenital defects. The goal is to restore the structure and function of the affected bone by providing a new graft with a dedicated blood supply, which enhances healing and integration with the surrounding bone.

Indications

• Nonunion or delayed union of broken bones.
• Large bone defects.
• Avascular necrosis (bone tissue death due to lack of blood supply).
• Tumor resection requiring bone reconstruction.
• Congenital bone abnormalities.

Preparation

• The patient may need to fast for at least 8 hours before the procedure.
• Blood tests and imaging studies (like X-rays, CT scans, or MRIs) may be required.
• Medications may need to be adjusted or stopped (e.g., blood thinners).
• Consent and discussion about anesthesia risks will be necessary.

Procedure Description

1. Anesthesia is administered (general or regional).
2. The donor bone site is identified and a surgical incision is made.
3. The bone graft is carefully harvested along with its blood supply.
4. The receiving site is prepared by cleaning and removing damaged tissue.
5. The graft is positioned and secured into place.
6. Microvascular anastomosis is performed to connect the blood vessels of the graft to those at the receiving site under a microscope.
7. Incisions are closed and bandaged.

Duration

The procedure typically takes between 4 to 8 hours, depending on the complexity and location of the graft.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Orthopedic or plastic surgeon, specialized in microvascular surgery.
• Anesthesiologist.
• Surgical nurses and technicians.
• Microvascular team for vessel connection.

Risks and Complications

• Infection.
• Blood clots.
• Graft rejection or failure.
• Complications specific to donor and recipient sites, including nerve damage.
• Prolonged swelling or pain.
• Anesthesia-related risks.

Benefits

• Restoration of bone structure and function.
• Increased likelihood of bone healing due to dedicated blood supply.
• Improved quality of life with restored mobility and reduced pain.
• Benefits might start to be realized a few weeks post-surgery as healing progresses.

Recovery

• Hospital stay of a few days for monitoring.
• Pain management with prescribed medications.
• Instructions on wound care and activity restrictions.
• Physical therapy may be recommended.
• Follow-up appointments to monitor graft integration and healing.
• Total recovery time can vary from several weeks to a few months.

Alternatives

• Non-surgical treatments such as bone stimulators or medications.
• Different types of bone grafts that don't involve microvascular anastomosis.
• Synthetic bone substitutes or metal implants.
• Each alternative has its own pros and cons regarding effectiveness, recovery time, and suitability for complex cases.

Patient Experience

• Patients might experience significant swelling and discomfort initially.
• Pain should be manageable with prescribed medications.
• Some limitations on movement and activity post-surgery.
• Gradual improvement in function and reduction in pain as the graft heals and integrates.