Title: Fresh-Frozen Structural Allografts in the Foot and Ankle
Authors: Mark S. Myerson, MD, Steven K. Neufeld, MD, Jaime Uribe, MD
Source: The Journal of Bone and Joint Surgery 2005; 87A(1): 113-120.
PODIATRIC RELEVANCE:
Traditionally, structural bone grafts have been harvested from the iliac crest, tibia, and calcaneus to cover large defects, but not without complications. This article suggests the use of structural fresh frozen allografts in reconstructive foot and ankle procedures as a great alternative to autografts.
METHODS:
A retrospective study consisted of seventy-five procedures and seventy-three patients who were operated on with structural allografts between January 1995 and December 1998. The structural allograft was used in procedures such as first MPJ arthrodesis, and osteotomy of the calcaneus. Every operation was performed with use of internal fixation. Risk factors that identified included diabetes with neuropathy, smoking, AVN, and prior surgery. The average graft size used was 1.85cm in diameter. Healing was determined by presence of trabeculation across the graft site, and the clinical absence of swelling and warmth.
RESULTS:
Healing occurred in 92% (69/75) at a mean of 4.0 months. At 3.5 years postoperatively, there was no evidence of graft subsidence or resorption. Eleven out of the seventy three patients developed a wound complication (dehiscence or infection) with two of them developing a deep infection.
COMMENTS:
Use of structural allografts is appropriate for reconstructive procedures in the foot and ankle. The grafts may be used successfully, with a low complication rate, in patients with risk factors for less satisfactory bone healing. Podiatrists needing corticocancellous grafts to cover large deficits have needed an orthopedic surgeon to harvest the graft, or have needed to become creative in harvesting grafts from the calcaneus or tibia. Fresh-frozen structural allografts offer a great option for podiatrists to cover large osseous defects in foot and ankle surgery.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.