{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:15:14Z","timestamp":1792282514429,"version":"4.4.0"},"reference-count":55,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T00:00:00Z","timestamp":1736899200000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The periosteum is the main organ responsible for bone regeneration. Vascularized Periosteal Grafts (VPG) have demonstrated exceptional efficacy and speed in facilitating bone union among children with challenging bone healing conditions. Despite their promising results, the overall impact of these interventions has yet to be comprehensively evaluated through systematic review. This systematic review aimed to provide comprehensive insights into bone union outcomes and complications related to the use of VPG in children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>MEDLINE\/PubMed, Embase, Web of Science, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">Clinicaltrials.gov<\/jats:ext-link>, and Cochrane Library were searched from database inception to September 2023 and screened for relevant studies. Data were collected regarding patient demographics, disease, treatment, anatomical location, graft used, donor and receptor vessels, skin paddle monitoring, follow\u2010up duration, time to union, consolidation, and complications. The correlation between age and bone union was assessed using Pearson and Spearman correlation coefficients, as appropriate. Study quality was assessed using the Methodological Index for Non\u2010randomized Studies Criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 15 studies involving 135 patients were included. All the studies were classified as Level 4 evidence. The mean MINORS score was 5.1\u2009\u00b1\u20091. The aim of the VPG was nonunion treatment in 90 patients (67%), nonunion prevention in 35 patients (26%), and bone union acceleration in 10 patients (7%). The origin of the bone union problem was traumatic in 59 cases (44%), congenital pseudoarthrosis of the tibia or fibula in 48 patients (35%), oncologic in 23 patients (17%), and infectious in 5 patients (4%). Nine different sources of periosteal flaps were used to enhance bone union. Bone union rate was 96% with a mean time of 4.2\u2009months (range 1\u201318\u2009months). Spearman test showed a non\u2010statistically significant negative correlation between age and bone union time (<jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.3, <jats:italic>p<\/jats:italic>\u2009=\u20090.759).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>VPGs are a safe and reliable treatment for promoting bone union, especially in the context of complex pediatric bone\u2010healing challenges.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.70021","type":"journal-article","created":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T14:47:56Z","timestamp":1736952476000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Vascularized Periosteal Grafts for Bone Union in Children: A Systematic Review"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1759-9868","authenticated-orcid":false,"given":"Francisco","family":"Soldado","sequence":"first","affiliation":[{"name":"Pediatric Hand Surgery and Microsurgery Unit Instituto de Investigaci\u00f3n Sanitaria HM Hospitales  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1635-8774","authenticated-orcid":false,"given":"Diego","family":"Gonzalez\u2010Morgado","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery Department Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Romero\u2010Larrauri","sequence":"additional","affiliation":[{"name":"Pediatric Orthopaedic Surgery San Juan de Dios Clinic  Lima Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trong\u2010Quynh","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedic Unit Saint Paul Hospital  Hachioji Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5039-8884","authenticated-orcid":false,"given":"Antonio Carlos","family":"da Costa","sequence":"additional","affiliation":[{"name":"Orthopaedic and Traumatology Surgery Department \u2010 Santa Casa de Sao Paulo Hand Surgery and Microsurgery Group  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Knorr","sequence":"additional","affiliation":[{"name":"Pediatric Hand Surgery and Microsurgery Unit Instituto de Investigaci\u00f3n Sanitaria HM Hospitales  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,15]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402\u2010002\u20100439\u2010y"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100040\u20101712095"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2020.06.013"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2018.08.019"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30233"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/17531934211026399"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30261"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01794953"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00454730"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02620523"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ocl.2006.10.008"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.5966\/sctm.2011\u20100056"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.00014"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30826"},{"key":"e_1_2_7_16_1","first-page":"163","article-title":"On the Cure of the Congenital PSEUDOARTHROSIS of the Tibia by Means of Periosteal Transplantation","volume":"2","author":"Codivilla A.","year":"1906","journal-title":"American Journal of Orthopedic Surgery"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/0007\u20101226(92)90213\u2010h"},{"key":"e_1_2_7_18_1","first-page":"187","article-title":"Periosteal Donor Site Regeneration in Rats","volume":"34","author":"Vieira S. 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