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J Reconstr Microsurg 2004; 20(4): 277-284
DOI: 10.1055/s-2004-824884
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Free Vascularized Osteocutaneous Fibular Graft to the Tibia in 51 Consecutive Cases

Kwang Suk Lee1 , Seung Beom Han1 , Jong Ryoon Baek1
  • 1Department of Orthopaedic Surgery, Korea University College of Medicine, Seoul, Korea
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Publication History

Accepted: 23 January 2004

Publication Date:
19 April 2004 (online)

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The authors reviewed retrospectively the clinical results of 51 consecutive cases of vascularized osteocutaneous fibular graft to the tibia for the reconstruction of extensive tibial bone and soft-tissue defects. The mean duration of follow-up was 31 months (range: 13 to 76 months). In the 51 procedures of free vascularized osteocutaneous fibula graft from the contralateral side, bony union was achieved in 48 cases at an average of 3.74 months after the operation, except for two cases of non-union and two cases of delayed union. Forty-eight cutaneous flaps survived, and three cutaneous flaps failed due to deep infection and venous thrombosis. All united fibulae hypertrophied during the follow-up periods. Stress fracture of the grafted fibula was the most common complication (16 cases), and it was treated with above-the-knee cast immobilization or internal fixation with a conventional cancellous bone graft. The free vascularized osteocutaneous fibular graft is recommended as a useful treatment modality for the reconstruction of extensive tibial defects combined with soft tissue injury.

KEYWORDS

Vascularized osteocutaneous fibular graft - tibial defects - soft-tissue repair

REFERENCES

  • 1 Brunnelli G, Guizzi P A, Battiston B, Vigasio A. A comparison of vascularized and non-vascularized bone transfer in rabbits: a roentgenographic, scintigraphic and histologic evaluation.  J Reconstr Microsurg. 1987;  3 301-307
    PubMedGoogle Scholar
  • 2 Doi K, Tominaga S, Shibata T. Bone grafts with microvascular anastomoses of vascular pedicles. An experimental study in dogs.  J Bone Joint Surg Am. 1977;  59 809-815
    CrossrefPubMedGoogle Scholar
  • 3 Lee K S, Park J W. Free vascularized osteocutaneous fibula graft to the tibia.  Microsurgery. 1999;  19 141-147
    CrossrefPubMedGoogle Scholar
  • 4 Moore J B, Mazur J M, Zehr D, Davis P K, Zook E G. A biomechanical comparison of vascularized and conventional autogenous bone grafts.  Plast Reconstr Surg. 1984;  73 382-386
    PubMedGoogle Scholar
  • 5 Sowa D T, Weiland A J. Clinical application of vascularized bone grafts.  Orthop Clin North Am. 1987;  18 257-273
    PubMedGoogle Scholar
  • 6 Weiland A J. Current concepts review. Vascularized free bone transplants.  J Bone Joint Surg Am. 1981;  63 166-169
    CrossrefPubMedGoogle Scholar
  • 7 Doi K, Kawakami F, Hiura Y, Oda T, Sakai K, Kawai S. One-stage treatment of infected bone defects of tibia with skin loss by free vascularized osteocutaneous graft.  Microsurgery. 1995;  16 704-712
    CrossrefPubMedGoogle Scholar
  • 8 Nonnenmacher J, Bahrm J, Moui Y. The free vascularized fibular transfer as a definitive treatment in femoral septic non-unions.  Microsurgery. 1995;  16 383-387
    PubMedGoogle Scholar
  • 9 Tu Y K, Yen C Y, Yeh W L, Wang I C, Ueng W N. Reconstruction of posttraumatic long bone defect with free vascularized bone graft: good outcome in 48 patients with 6 years follow up.  Acta Orthop Scand. 2001;  72 359-64
    CrossrefPubMedGoogle Scholar
  • 10 Wood M B, Cooney W P. Vascularized bone segment transfers for management of chronic osteomyelitis.  Orthop Clin North Am. 1984;  15 461-471
    PubMedGoogle Scholar
  • 11 Perkins R, Skirving A P. Callus formation and the rate of healing of femoral fractures in patients with head injuries.  J Bone Joint Surg Br. 1987;  69 521-524
    PubMedGoogle Scholar
  • 12 Taylor G I, Miller G D, Ham F J. The free vascularized bone graft. A clinical extension of microvascular technique.  Plast Reconstr Surg. 1975;  55 533-544
    Google Scholar
  • 13 De Boer H H, Wood M B. Bone changes in the vascularized fibualr graft.  J Bone Joint Surg Br. 1989;  71 374-378
    PubMedGoogle Scholar
  • 14 Chee-Kwang L, Pho R W, Anam-Kueh K, Satku K. Infection of vascularized fibular graft.  Clin Orthop. 1996;  323 163-172
    PubMedGoogle Scholar
  • 15 Takabe K, Nakagawa A, Minami H, Kanazawa H, Hirohata K. Role of the fibula in weight-bearing.  Clin Orthop. 1984;  184 289-292
    PubMedGoogle Scholar
  • 16 Lambert K L. The weight-bearing function of the fibula. A strain gauge study.  J Bone Joint Surg Am. 1971;  53 507-513
    PubMedGoogle Scholar
  • 17 Youdas J W, Wood M B, Cahalan T D, Chao E Y. A quantative analysis of donor site morbidity after vascularized fibular transfer.  J Orthop Res. 1988;  6 521-529
    PubMedGoogle Scholar
  • 18 Shpitzer T, Neligan P, Boyd B, Gullane P, Gur E, Freeman J. Leg morbidity and function following fibula free flap harvest.  Ann Plastic Surg. 1997;  38 460-464
    PubMedGoogle Scholar
  • 19 Srdan B, Craig H J, Stephan J F. Free fibular donor-site morbidity: the Mayo experience with 100 consecutive harvests.  J Reconstr Microsurg. 2000;  16 107-110
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Pacelli L L, Gillard J, McLoughlin S W, Buehler M J. Biomechanical anlysis of donor-site ankle instability following free fibular graft harvest.  J Bone Joint Surg. 2003;  85A 597-603
    PubMedGoogle Scholar
  • 21 Vail T P, Urbaniak J R. Donor-site morbidity with use of vascularized autogenous fibular grafts.  J Bone Joint Surg Am. 1996;  78 204-211
    PubMedGoogle Scholar
  • 22 Lee K S, Han S B, Hwang I C, Song H S. The evaluation of the donor site after transfer of free osseous and osteocutaneous flaps of fibula.  J Korean Microsurg Soc. 2001;  10 75-80
    PubMedGoogle Scholar

Seung Beom HanM.D. 

Department of Orthopaedic Surgery, Korea University Hospital

126-1, 5Ka, Anam-Dong, SungBuk-ku, Seoul, 160-705, Korea