Transplantation of the free fibular osteocutaneous flap for repair of long bone defect of the upper extremity

Abstract

Objective To explore the clinical application and results of free fibular osteocutaneous flap transplantation for repair of long bone defect of the upper extremity.Methods From June 2000 to December 2010,free fibular bone flap was applied to repair long bone defect of the upper extremity in 12 cases,among which 4 cases had osteocutaneous flap.Of the 12 cases,there were 11 males and 1 female.Their ages ranged from 19 to 55 years old,with 35 years old on average.The fibular bone flap was used to repair humerus shaft bone defects in 2 cases,ulnar bone defects in 6 cases,and radius bone defects in 4 cases.The area of the cutaneous fibular flap ranged from 1.5 cm × 2.0 cm to 12.0 cm × 16.0 cm.The length of fibular bone flap ranged from 6.0 cm to 20.0 cm. Results All 12 cases were successfully follow-up.The mean follow-up duration was 2 years and 5 months.All 4 cutaneous flaps survived completely.Wounds healed in the primary attempt in 11 cases and in the secondary attempt in 1 case (healing time ranged from 12 to 18 days).Bone healing time ranged from 3 to 6 months (4 months on average) in fibula transplantation.The Enneking score system was applied to evaluate the upper extremity function.Of the 12 cases,the mean score was 27 (their scores ranged from 22 to 29).There was no functional impairment of the donor sites.Conclusion Despite the technical difficulty and risk,transplantation of the free fibular osteocutaneous flap is an optimal method to repair long bone defect of the upper extremity in that it can repair defects of the bone and soft tissue simultaneously. Key words: Transplantation; Upper extremity; Surgical flaps; Fibula; Bone defect