Versatility of Vascularized Fibular Graft in Forearm Bone Loss: From Initial Treatment to Secondary Nonunion Treatment

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PurposeManaging mangled forearms poses a significant challenge for orthopedic and plastic surgeons. The vascularized fibular graft (FVFG) is a commonly used technique for addressing this complex issue. This retrospective study aims to assess the outcomes of advanced treatment for complex forearm bone loss necessitating microsurgical treatment with a vascularized fibula flap. MethodsPatients treated with vascularized fibula graft (VFG) between January 2010 and December 2022 were included in this analysis. Physical and radiographic evaluations were performed for all patients, and they completed patient-reported outcome measures (PROMs) such as the DASH, Mayo Wrist score, and VAS-Pain scores for both the recipient and donor sites. Patients treated with one-bone forearm reconstruction were also assessed using the Outcome Score of the one-bone forearm according to Peterson (OBF). ResultsA total of 26 cases were treated with VFG for forearm bone defect reconstruction (13 for primary treatment and 13 for secondary treatment of non union). VFG was employed to create a one-bone forearm in 4 cases, a double barrel in 3 cases, and an osteocutaneous composite flap in 9 cases. The average bone defect measured 81 ± 3.4 mm (range 50-150 mm). Bone healing was achieved at an average of 8.3 months ± 5.5 months (4-15 months)., with nonunion at one docking point observed in 8 cases necessitating revision. At the follow-up endpoint, patients reported an average DASH score of 13.5%, a Mayo Wrist score of 80%, and VAS-Pain's score was 3/10. The VAS-Pain outcome at the donor site was rated at 4/10. OBI's mean was 7/10. ConclusionsFVFG stands as a viable option for mangled forearm reconstruction. Whether through the double barrel technique or as an osteocutaneous composite graft, FVFG allows for the simultaneous reconstruction of both forearm bones and associated soft tissue injuries.