Reliable reconstructive flaps require convenient vascular supply. Thus, precise description of the vascular patterns of external ear is not completely elucidated.This anatomical study aims to provide comprehensive data of the arterial network of the auricular region, anastomosis, and patterns of arterial dependence regarding external ear subunits.After dyed latex injections in the external carotid artery, eleven auricles have been carefully dissected to examine the vascular network of the auricular region.In all cases, the posterior auricular artery (PAA) supplied the cranial side of the auricle, as well as the concha on the lateral side through consistent perforating branches. The superficial temporal artery (STA) network supplied the upper third of the lateral aspect of the auricle. The authors' dissections showed a clear dominance of the PAA supply. However, the two arteries consistently developed anastomoses particularly in the cranial upper third of the auricle.Consistent branches and anastomoses between the PAA and the STA network provide reliable pedicles for auricular and facial reconstruction.
ABSTRACT Introduction Reconstructing large bone defects for lower limb salvage in the pediatric population remains challenging due to complex oncological or septic issues, limited surgical options, and lengthy procedures prone to complications. The vascularized double‐barreled fibula free flap is pivotal for reconstructing large bones. In this article, we report our experience with this technique in the surgical management of pediatric tibial bone defects. Materials and Methods We conducted a retrospective analysis of patients under 18 years of age who underwent tibial reconstruction using a double‐barreled fibula free flap at our center between 2004 and 2023. Collected data included demographic information, operative details, time to bone consolidation and full weight‐bearing, and functional outcomes using the Musculoskeletal Tumor Society (MSTS) score. Results Eight patients (5 females, 3 males) with a mean age of 12.5 years (range 5–17) were included. The average tibial defect length was 11.2 cm (range 7–14 cm), affecting the proximal tibia in 4 cases (50%), the middle third in 3 cases (37.5%), and the distal third in 1 case (12.5%). Reconstruction followed oncologic resection in 7 patients (87.5%) and addressed congenital pseudarthrosis in 1 patient (12.5%). One patient died of sarcoma. Six patients (75%) achieved full weight‐bearing within a median of 7 months (range 6–16) and a bone consolidation at 9 months in median (range 6–18). One reconstruction (12.5%) failed due to septic pseudarthrosis leading to a below‐knee amputation. The mean MSTS score was 81.65 (range 63.3–100). Conclusion This study is the first to focus on pediatric tibial reconstructions using the double‐barreled vascularized fibula free flap. It highlights the technique's reliability for reconstructing tibial defects, particularly in intermediate‐sized cases (7–14 cm). This single‐stage procedure minimizes stress fracture risk, enables earlier weight‐bearing, and is an alternative to the Capanna technique without requiring an allograft.
We have evaluated the effect of internal and external osteosynthesis devices on the efficacy of vancomycin treatment in a rabbit model of methicillin-resistant Staphylococcus aureus (MRSA)-induced post-traumatic osteomyelitis.Double tibial osteotomies in female New Zealand rabbits were performed, inoculated with a MRSA strain, then fixed with an intramedullary rod. A debridement was performed 4 days later for each rabbit, and a bacterial count in pus was determined (B1). In the first group (G1), the osteosynthesis material was removed and replaced by a new sterile nail. In the second group (G2), the intramedullary rod was removed and then replaced by an external fixator. Immediately after surgery, G1 and G2 rabbits were treated with vancomycin (60 mg/kg twice a day). The animals were sacrificed at the end of a 5-day period, and a bacterial count in pus was performed again (B2).The difference of log(10) colony forming units per milliliter (CFU/ml) (B2-B1) was -1.2 +/- 0.5 and -2.9 +/- 1.1, respectively, for G1 and G2.The efficacy of vancomycin treatment increased after removal of the internal osteosynthesis device.
Immobilization of septic arthritis is an ancient and always recommended notion. Before discovery of antibiotics, immobilization allowed an articular ankylosis in functional position. Since discovery of antibiotic chemotherapy, immobilization is justified for its antalgic and anti-inflammatory qualities. However, Salter demonstrated experimentally the interest of continuous passive mobilization during septic arthritis. The authors also demonstrated the deleterious effects of immobilization on articular cartilage during Staphylococcus aureus induced arthritis in a rabbit model. The authors compared two series of children treated for septic arthritis. All children were treated by articular lavage, and by intravenous antibiotic chemotherapy during 10 days, then by enteral antibiotic chemotherapy for 6 supplementary weeks. 14 children were immobilized during 1 month, while 14 others were mobilized from the first days. Consumption and class of antalgic chemotherapy, inflammatory balances (Blood Count, C Reactiv Protein), articular range motion during of the first and sixth month clinical review, were compared. Only articular range motion noted during the clinical review of the first month were significantly different in the two groups. Articular range motion of the not immobilized children were close of normal, while the other children suffered from articular stiffness. Immobilization had no beneficial effects either in pain or in correction of the inflam-matory process.
