{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:40:55Z","timestamp":1790419255221,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,9,19]],"date-time":"2020-09-19T00:00:00Z","timestamp":1600473600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100008061","name":"Fundaci\u00f3n Mutua Madrile\u00f1a","doi-asserted-by":"publisher","award":["FFM\u20102012\u201018"],"award-info":[{"award-number":["FFM\u20102012\u201018"]}],"id":[{"id":"10.13039\/100008061","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>In the last years, limb salvage has become the gold standard treatment over amputation. Today, 90% of extremity osteogenic sarcomas can be treated with limb salvage surgery. However, these reconstructions are not exempt from complications. Massive allografts have been associated to high risk of nonunion (12\u201357%), fracture (7\u201330%) and infection (5\u201321%). Association of vascularized periosteum flap to a massive bone allograft (MBA) has shown to halve the average time of allograft union in clinical series, even compared to vascularized fibular flap. Creeping substitution process has been reported in massive allograft when periosteum flap was associated. However, we have little data about whether it results into allograft revitalization. We hypothesize that the association of a periosteum flap to a bone isograft promotes isograft revitalization, defined as the colonization of the devitalized bone by new\u2010form vessels and viable osteocytes, turning it vital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Forty\u2010four New Zealand white male rabbits underwent a 10\u2009mm segmental radial bone defect. In 24 rabbits the bone excision included the periosteum (controls); in 20 rabbits (periosteum group) bone excision was performed carefully detaching periosteum in order to preserve it. Cryopreserved bone isograft from another rabbit was trimmed and placed to the defect gap and was fixed with a retrograde intramedullar 0.6\u2009mm Kirschner wire. Rabbits were randomized and distributed in 3 subgroups depending on the follow\u2010up (control group: 5 rabbits in 5\u2010week follow up group, 8 rabbits in 10\u2010week follow\u2010up group, 7 rabbits in 20\u2010week follow\u2010up group; periosteum group: 5 rabbits in 5\u2010week follow up group, 7 rabbits in 10\u2010week follow\u2010up group, 7 rabbits in 20\u2010week follow\u2010up group). Fluoroscopic images of rabbit forelimb were taken after sacrifice to address union. Each specimen was blindly evaluated in optical microscope (magnification, \u00d74) after hematoxylin and eosin staining to qualitative record: presence of new vessels and osteocytes in bone graft lacunae (yes\/no) to address revitalization, presence of callus (yes\/no) and woven bone and cartilage tissue area (mm<jats:sup>2<\/jats:sup>) to address remodeling (osteoclast resorption of old bone and substitution by osteoblastic new bone formation).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>No isograft revitalization occurred in any group, but it was observed bone graft resorption and substitution by new\u2010formed bone in periosteum group. This phenomenon was accelerated in 5\u2010week periosteum group (control group: 49.5 <jats:styled-content>\u00b1<\/jats:styled-content> 9.6\u2009mm<jats:sup>2<\/jats:sup> vs. periosteum group: 34.9 <jats:styled-content>\u00b1<\/jats:styled-content> 10.4\u2009mm<jats:sup>2<\/jats:sup>; <jats:italic>p<\/jats:italic> = .07). Remodeled lamellar bone was observed in both 20\u2010week groups (control group: 6.1 <jats:styled-content>\u00b1<\/jats:styled-content> 6.3\u2009mm<jats:sup>2<\/jats:sup> vs. periosteum group: 5.8 <jats:styled-content>\u00b1<\/jats:styled-content> 3.0\u2009mm<jats:sup>2<\/jats:sup>, <jats:italic>p<\/jats:italic> = .67). Periosteum group showed complete integration and graft substitution, whereas devitalized osteons were still observed in 20\u2010week controls. All periosteum group samples showed radiographic union through a bone callus, whereas controls showed nonunion in eight specimens (Union rate: control group 60% vs. periosteum group 100%, <jats:italic>p<\/jats:italic> = .003).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Association of vascularized periosteum to a massive bone isograft has shown to accelerate bone graft substitution into a newly formed bone, thus, no bone graft revitalization occurs.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.30647","type":"journal-article","created":{"date-parts":[[2020,9,19]],"date-time":"2020-09-19T15:36:41Z","timestamp":1600529801000},"page":"157-164","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Effect of vascularized periosteum on revitalization of massive bone isografts: An experimental study in a rabbit model"],"prefix":"10.1002","volume":"41","author":[{"given":"David","family":"Barastegui","sequence":"first","affiliation":[{"name":"Orthopedic and Trauma Surgery, Instituto Cugat Fundaci\u00f3n Garc\u00eda Cugat, Hospital Quiron  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1807-5284","authenticated-orcid":false,"given":"Irene","family":"Gallardo\u2010Calero","sequence":"additional","affiliation":[{"name":"Hand Surgery Unit, Orthopaedic Surgery Hospital Universitari Vall d'Hebron  Barcelona Spain"},{"name":"Universidad Aut\u00f3noma de Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Rodriguez\u2010Carunchio","sequence":"additional","affiliation":[{"name":"Department of Pathology, Faculty of Medicine, Hospital Clinic  Barcelona Spain"},{"name":"University of Vic. Central University of Catalonia (UVic\u2010UCC)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6820-3494","authenticated-orcid":false,"given":"Sergi","family":"Barrera\u2010Ochoa","sequence":"additional","affiliation":[{"name":"icatMA Hand and Microsugery Unit, ICATME Hospital Universitari Quiron\u2010Dexeus  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Knorr","sequence":"additional","affiliation":[{"name":"Pediatric Hand Surgery and Microsurgery Unit Barcelona University, Childrens Hospital HM Nens  Barcelona Spain"},{"name":"Unidad UCA Mikel Sanchez, Vithas San Jos\u00e9  Vitoria Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1137-289X","authenticated-orcid":false,"given":"Danilo","family":"Rivas\u2010Nicolls","sequence":"additional","affiliation":[{"name":"Department of Plastic, Aesthetic and Reconstructive Surgery Hospital Universitari Vall d'Hebron  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1759-9868","authenticated-orcid":false,"given":"Francisco","family":"Soldado","sequence":"additional","affiliation":[{"name":"Pediatric Hand Surgery and Microsurgery Unit Barcelona University, Childrens Hospital HM Nens  Barcelona Spain"},{"name":"Unidad UCA Mikel Sanchez, Vithas San Jos\u00e9  Vitoria Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,9,19]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-015-2870-z"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2018.08.019"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30261"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02620523"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ocl.2006.10.008"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181904baf"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2004-823106"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13193-013-0229-8"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200008000-00025"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200107000-00001"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199173080-00002"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/laban.732"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/CORR.0000000000000400"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-200501000-00010"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.7150\/jbji.40337"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2014.12.027"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000141652.93178.10"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1089\/ten.tea.2015.0030"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-017-2063-0"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000001637"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11751-012-0130-y"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30063"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e31824b2843"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.21985"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.22342"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.22159"},{"issue":"6","key":"e_1_2_7_28_1","first-page":"1323","article-title":"Healing of a critical\u2010sized defect in the rat femur with use of a vascularized periosteal flap, a biodegradable matrix, and bone morphogenetic protein","volume":"87","author":"V\u00f6gelin E.","year":"2005","journal-title":"The Journal of Bone and Joint Surgery. 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