Free Fibula Flap Elbow-Joint Hemiarthroplasty Reconstruction for Chronic Osteomyelitis of the Distal Humerus

ABSTRACT

The vascularized fibula flap has become a major tool in upper limb reconstruction. Free fibula flap reconstructions of the humeral part of the shoulder and the radial part of the wrist joints are well-documented, but reports of elbow joint reconstruction are rare.

The authors report a 53-year-old patient with chronic osteomyelitis of the distal humerus that was unsuccessfully treated by many local surgical debridements and long-term systemic antibiotics. The patient underwent a wide debridement of the distal two-thirds of the humerus, and a spacer was inserted to fill the bony humeral gap. At a second stage, the distal humerus was reconstructed with a free fibula flap that included the proximal fibular head. The fibular shaft was used to bridge the bony gap and the fibular head created an elbow joint with the olecranon process. At an 18-month follow-up after surgery, the patient has stable and sufficient function of his elbow joint with no signs of infection.

The free fibula flap has an important role for distal humerus reconstruction, both for bridging the bony gap with a vascularized bone, and for restoring elbow joint function.

KEYWORDS

Free fibula - distal humerus - elbow hemiarthroplasty

REFERENCES

• 1 Taylor G I, Miller G D, Ham F J. The free vascularized bone graft. A clinical extension of microvascular technique.  Plast Reconst Surg. 1975;  55 533-544
• 2 Kumta S M, Leung P C, Yip K, Hung L K, Panozzo A, Kew J. Vascularized bone grafts in the treatment of juxta-articular giant-cell tumors of the bone.  J Reconstr Microsurg. 1998;  14 185-190
• 3 Gao Y H, Ketch L L, Eladoumikdachi, Netscher D T. Upper limb salvage with microvascular bone transfer for major long-bone segmental tumor resection.  Ann Plast Surg. 2001;  47 240-246
• 4 Wada T, Usui M, Isu K, Yamawakii S, Ishii S. Reconstruction and limb salvage after resection for malignant bone tumors of the proximal humerus. A sling procedure using a free vascularized fibula graft.  J Bone Joint Surg Br. 1999;  81 808-813
• 5 Gerwin M, Weiland A J. Vascularized bone grafts to the upper extremity.  Indications and techniques. Hand Clin. 1992;  8 509-523
• 6 Minami A, Kutsumi K, Takeda N, Kaneda K. Vascularized fibular graft for bone reconstruction of the extremities after tumor resection in limb-saving procedures.  Microsurgery. 1995;  16 56-64
• 7 Usui M, Murakami T, Naito T, Wada T, Takahashi T, Ishii S. Some problems in wrist reconstruction after tumor resection with vascularized fibular-head graft.  J Reconstr Microsurg. 1996;  12 81-88
• 8 Dautel G, Duteille F, Merle M. Use of osteocutaneous “double-barrel fibular flaps” in limb reconstruction: four clinical cases.  Microsurgery. 2001;  21 340-344
• 9 Manfrini M, Innocenti M, Ceruso M, Mercuri M. Original biological reconstruction of the hip in a 4-year-old girl.  Lancet. 2003;  361 140-142
• 10 Kimura K, Tatezaki S, Ishii T, Yonemoto T, Shigehara T, Takenouchi T. Hemiarthroplasty of the elbow with a vascularized fibular graft after excision of Ewing's sarcoma of the proximal ulna: a case report.  Jpn J Clin Oncol. 2002;  32 430-434
• 11 Yajima H, Tamai S, Ono H, Kizaki K. Vascularized bone grafts to the upper extremities.  Plast Reconstr Surg. 1998;  101 727-735
• 12 Heitmann C, Erdmann D, Levin L S. Treatment of segmental defects of the humerus with an osteoseptocutaneous fibular transplant.  J Bone Joint Surg Am. 2002;  84 2216-2223
• 13 Jupiter J B, Gerhard J H, Guerrero J, Nunley J A, Levin S L. Treatment of segmental defects of the radius with use of the vascularized osteoseptocutaneous fibular autogenous graft.  J Bone Joint Surg Am. 1997;  79 542-550
• 14 Gianoutsos M P, Marsden F W, McCarthy S W, Lee K K. Ulnar adamatinoma: en bloc excision and fibular osteoseptocutaneous flap reconstruction.  J Hand Surg Am. 1994;  19 495-499
• 15 Guelinckx P J, Sinsel N K. Refinements in the one-stage procedure for management of chronic osteomyelitis.  Microsurgery. 1995;  16 606-611
• 16 Weiland A J. Current concepts review: vascularized free bone transplants.  J Bone Joint Surg Am. 1981;  63 166-169
• 17 Sperling J W, Pritchard D J, Morrey B F. Total elbow arthroplasty after resection of tumors at the elbow.  Clin Orthop. 1999;  367 256-261