MICROSURGICAL BONE TRANSPLANTS: IS IT NECESSARY TO PERFORM VENOUS ANASTOMOSIS IN THE BONE-ONLY GRAFT? A SYSTEMATIC REVIEW AND METANALYSIS
Bibliographic record
Abstract
BACKGROUND: Non-unions are one of the major challenges that orthopaedic surgeons must face. Vascularized bone transplants are widely used to treat these bony defects. OBJECTIVES: The aim of this systematic review and meta-analysis was to investigate whether venous anastomosis in the bone-only graft increases the survival rate of the flap. METHODS: We conducted this review in accordance with the PRISMA guidelines. PubMed, Embase, and the Cochrane Library were systematically searched from the inception through January 2025. Studies reporting results about bone graft performed with microsurgical anastomosis of both vein and artery and studies reporting the results of bone graft with only arterial anastomosis were selected and compared. Data quality was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: The literature search yielded 1.140 papers, but only 26 papers were included in the systematic review. Heterogeneity was high, so a subgroup analysis was performed. Twenty papers dealt with only arterial anastomosis with a pooled failure rate at 4.5%. On the other side, six papers reported both vein and artery anastomosis with a pooled failure rate at 1.6%. The subgroup analysis of the papers in which venous anastomosis was made, however, did not allow to demonstrate that the venous anastomosis is truly protective (p = 0.3133). CONCLUSION: Bone vascularized grafts are an indispensable therapeutic technique. The results of this review are not definitive about the role of the venous anastomosis, but it is not possible to exclude its protective role on the transplant survival. More targeted studies are essential to confirm it.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.024 | 0.060 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.020 | 0.033 |
| Bibliometrics | 0.010 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".