Pedicle bone grafting
In pedicle bone grafting, the fashioned graft maintains its connection with the surrounding soft tissues, which ensures its adequate blood supply.
Historical aspect:
- The method was first introduced into surgical practice by N.I. Pirogov in 1852. He performed a osteoplastic foot amputation, which helped preserve its weight-bearing function.
- Subsequently, surgeons R. Gritti and Yu.K. Shimanovsky developed a similar osteoplastic approach for lower leg amputation.
Special techniques:
- «Russian lock» (N.V. Sklifosovsky's method) is a specific type of osteotomy that provides the most secure fixation of bone fragments.
- During craniotomy, musculocutaneous-bone or bone flaps are actively used to reliably close resulting defects of the cranial vault.
Free bone grafting
Free bone grafting involves the transplantation of bone tissue without preserving a vascular pedicle.
Depending on the origin of the material, there are two main types:
- Autotransplantation — using the patient's own bone.
- Allotransplantation — using donor or preserved bone.
Indications for bone autografts:
- The need to fix bone fragments in cases of delayed fracture consolidation.
- Surgical treatment of pseudoarthrosis (non-unions).
- Filling bone cavities and defects resulting from chronic osteomyelitis.
Characteristics of bone allografts
Donor bone tissue requires special preparation before use. The main methods of allograft preservation are lyophilization and rapid freezing at ultra-low temperatures (-70 to -196 °C).
Biological properties: Transplanted allografts do not remain in the body permanently — they undergo resorption within 2–3 years. A crucial property of donor bone is that it does not suppress the patient's own bone tissue's ability to regenerate in the surgical area.
Application scope of allografts:
- Replacement of various bone tissue defects.
- Use as fixators in spinal surgeries.
- Reconstruction of structures during joint resection.
Briefly: answers to topical questions
What is N.V. Sklifosovsky's «Russian lock» technique?
N.V. Sklifosovsky's «Russian lock» technique is an osteotomy method for secure fixation of bone fragments. It belongs to special methods of pedicle bone grafting.
Features of this type of osteoplasty:
- Graft — retains its connection with soft tissues.
- Blood supply — is maintained through preserved tissue connections.
The main goal of such surgical interventions is to restore lost functions, primarily weight-bearing, as well as to restore the cosmetic shape of the damaged organ.
Class and exam questions
What is the main difference between free and non-free bone grafting?
In non-free grafting, the graft maintains its connection with soft tissues and blood supply. In free transplantation, the vascular pedicle is not preserved.
What is the method of autotransplantation used for?
Autologous bone is used to treat pseudoarthrosis, fix fragments in delayed fracture healing, and fill cavities in chronic osteomyelitis.
Do allografts interfere with the growth of the patient's own bone?
No, they do not suppress the bone's own regenerative capacity and gradually resorb within 2–3 years.
What else to study on this topic
- Osteoplastic foot amputation by N.I. Pirogov
- Gritti-Shimanovsky lower leg amputation
- «Russian lock» osteotomy technique
- Bone tissue preservation methods (lyophilization)
- Surgical treatment of pseudoarthrosis
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