1. 소아에서 골 결손에 대한 골막보존 비골이식 정성택. 조성범. 김기형. 신증봉 Chonnam National University Hospital Gwangju, Korea

2. Introduction Problem of Bone Graft in children –Limitation of amount –Donor site complications

3. Introduction Free Fibular graft (FFG) –Preferred method of reconstruction Strong bicortical graft Mechanical strength –Donor site morbidity Motor impairment (FHL. PL. PB) Ankle stiffness and instability

4. Purpose To introduce the surgical procedure to reduce the donor site morbidity in free fibular graft (FFG) by periosteum preservation in children

5. Free fibular graft with periosteum preservation 16 patients (M:F=14:2) Age : 2 - 13 Yrs(mean 8.25 Yrs) F/U duration : 6 – 36 Mos (mean 17 Mos ) Materials

6. Primary disease –Aneurysmal bone cyst : 4 –Simple bone cyst : 3 –Fibrous dysplasia : 2 –Osteofibrous dysplasia : 2 –Osteosarcoma : 1 –Ewing’s sarcoma : 1 –Non-union : 3 Materials

7. 2.Scaffold graft 4. Regeneration 1.subperiosteal fibular resection 3. Periosteum repaired Surgical procedure

8. Longitudinal incision on periosteum and free fibular resection Periosteal sleeve is preserved circumferentially and vascularity is maintained by soft tissue attachment

9. Osteogenesis augmentation through scaffold graft and periosteal repair Surgical procedure

10. Case

11. Case 1: 2/M Ewing’s Sarcoma, humerus Preop

12. Case 1: 2/M Ewing’s Sarcoma, humerus Postop 1mo Postop 4mo Postop 1mo Postop 4mo Postop 6mo

13. Case 2 : 6/M ABC, Lt proximal femur Preop Postop imm

14. Case 2 : 6/M ABC, Lt proximal femur Postop 3mosPostop 12mos

15. Case 3: 7/M Recurred SBC, Rt. proximal femur Preop. Postop imm.

16. Case 3: 7/M Recurred SBC, proximal femur,Rt Postop 7mos Postop 12mos

17. Size of the graft : 3-14cm (mean 7cm) % of total fibula taken : 20-60% (mean 37%) Length of distal fibular remained : 4-6cm Complete regeneration : 16 cases (100 %) –Mean time for remodelling : 9wks (4 –12 wks) Motor impairment, Ankle instability – None Results

18. Regeneration process Scaffold (or allograft) graft Absorption (only to calcium sulfate) Restoration of fibular shape Remodeling Recanalization

19. Calcium sulfate Postop immPostop 2wksPostop 3wksPostop 2mosPostop 4mos Scaffold( or allograft) graft Absorption (only to calcium sulfate) Restoration of fibular shape Remodeling Recanalization

20. Postop imm Postop 2mosPostop 4mosPostop 7mosPostop 16mos allograft Restoration of fibular shape Remodeling Recanalization

21. Discussion Bone defect in Children Bone tumor Trauma Infection Reconstruction of bone defect Bone graft Various bone graft alternatives Internal bone transport (Ilizarov)

22. Conclusion FFG with periosteal preservation –Simple technique –Wide range of amount –Decrease the morbidity with biological and anatomical regeneration

23. Thank you very much !!!