Transplantation of free fibular flap with monitoring flap for repair of forearm bone defect: surgical techniques and treatment outcome

Abstract

Objective To explore the treatment outcome and surgical techniques of free fibular flap with monitoring flap for repair of forearm ulna or radius defect. Methods From February 2005 to January 2016, free fibular flap transplantation with monitoring flap was applied to repair forearm bone defect in 11 cases. There were 2 cases with ulna defect and 9 cases with radius defect. The range of defect was 3 to 10 cm in length with an average of 5.0 cm. Results All 11 monitoring flaps survived, and no vascular crisis occurred. The monitoring flap of one case had blister and healed spontaneously. All the patients were follow-up for 6 to 36 months (average, 14 months). The bone graft healing time was 3 to 10 months (average, 5 months). The ranges of wrist and elbow joint motion were almost the same as those of the uninjured side, while the rotate functions were limited. The range of pronation was 0° to 70°and that of supination was 0° to 50°. Two cases of patients with tumor had no tumor recurrence. The donor site had no significantly dysfunction except two cases with toe flexor strength declining. Conclusion Despite the technical difficulty and operation risk, transplantation of free fibular flap with monitoring flap is an ideal method to repair forearm bone defect. The skin island can monitor the blood flow of bone flap and improve the soft tissue conditions to achieve reliable healing. Key words: Transplantation; Forearm injuries; Fibular flap; Bone defect