Free Fibula Transplantation Research Articles

Possible applications of free microsurgical fibula transplantation in the reconstruction of complex bone defects in the extremities: review of the literature and case series

Extensive osseous defects of the extremities following trauma and tumour resection represent a major challenge for plasticreconstructive surgical teams. Defect reconstruction by free microsurgical fibula transplantation has become a standard method but is associated with a considerable rate of complications. The aim of the present work is to provide an up-to-date overview of the various reconstruction methods and to report our personal experiences with free fibula transplantation in a case series. The literature search on the subject was performed on Pubmed and Web of Science, and a retrospective collection of data was conducted based on our own cases, including clinical and radiological data. From 2007 to 2018, free fibula transplantation was performed in 11 patients under the guidance of the senior author (MS). The defects were a result of pseudarthrosis in four cases, osteitis in three, and a tumour in two cases. Two patientssustained a primary defect due to a high-energy trauma. In nine cases the upper limb was affected; only two had the defect in the lower limb. No graft failure was observed. In eight cases, an osteoseptocutaneous graft was taken; in two cases there was a post-operative loss of the skin island. Fibula length ranged between 5 and 22 cm. In all cases, bony integration of the graft was complete. The range of motion in the affected limb after physiotherapy was very good to satisfactory. Extensive bone defect reconstruction using free fibula flaps is undoubtedly the gold standard method, but the high rate of complications described in the literature necessitates a strict indication in due consideration of possible alternatives. Close cooperation between the disciplines of plastic reconstructive surgery and trauma orthopaedics is indispensable.

Reconstruction of Large Bone Defects and Complex Non-Unions Using a Free Fibular Bone Graft and a Supplementary Allograft.

Large bone defects or complex pseudarthrosis represent an interdisciplinary challenge. Established surgical procedures include autogenous cancellous bone graft, the Masquelet technique or bone transfer via segment transport as well as free microvascular bone transplantation. However, the successful use of all these techniques requires a specialized center with great interdisciplinary expertise. In the following case series we describe the technique of free fibula transplantation and additional allograft. In both cases a good functional result with full mechanical strength of the affected extremity and satisfactory patient comfort has been achieved. In the second case, implant failure with the necessity of revision endoprosthetics occurred during the procedure.

Free-fibula transplantation for medication-related osteonecrosis of the jaw in a patient treated with sunitinib and bisphosphonate : a case report

Free-fibula transplantation for medication-related osteonecrosis of the jaw in a patient treated with sunitinib and bisphosphonate : a case report

Assessment of vascularized free fibula transplantation revealing a congenital aplastic posterior tibial artery: a case report

IntroductionAnatomical abnormalities in the lower limb vessels are uncommon. However, the preoperative evaluation of the anatomical variations is very important for planning the operation procedure to prevent jeopardizing the donor leg.Case presentationIn this case report, a 23-year-old Asian woman who was scheduled to have vascularized free fibula transplantation for reconstruction of her wrist after excision of bone tumor in her distal radius, was found to have congenital aplastic posterior tibial arteries in both legs. These findings were found on magnetic resonance angiography (our preferred methodology due to its simplicity). We planned testing the sufficiency of her pedal pulses after temporarily clamping her peroneal artery but prior to harvesting, to ensure minimal risk to the longevity of her donor leg. During the operation, after dissection of a 10cm segment of her fibula with the peroneal artery, the peroneal artery proximal to the graft was temporarily clamped and the tourniquet was released. As adequate sustainable pedal pulses were confirmed, the graft was harvested and transplanted to her wrist. There was no morbidity in her right leg postoperatively and the union of the grafted fibula was substantiated 10 months postoperatively.ConclusionsWe concluded two findings: firstly, for accurate preoperative planning of a vascularized free fibula procedure, examination of the bilateral lower leg vasculature either by angiography or other imaging should be performed. Secondly, abnormalities are not in themselves reason to abandon the vascularized free fibula procedure. We contend that pedal pulses should be evaluated preoperatively and provided that adequate foot circulation can be confirmed (by temporarily clamping the vessels and releasing the tourniquet during the operation prior to harvesting the free vascularized fibula) the procedure should be successful without jeopardizing the donor leg.

扩大碟形术加带血管蒂腓骨游离移植治疗胫骨慢性骨髓炎<br> Treatment of Chronic Tibia Osteomyelitis by Enlarging Saucerization and Free Fibula Transplantation with Vascular (FTV)

扩大碟形术加带血管蒂腓骨游离移植治疗胫骨慢性骨髓炎<br> Treatment of Chronic Tibia Osteomyelitis by Enlarging Saucerization and Free Fibula Transplantation with Vascular (FTV)

扩大碟形术加带血管蒂腓骨游离移植治疗胫骨慢性骨髓炎

目的：探索扩大碟形术加带血管蒂腓骨游离移植治疗胫骨慢性骨髓炎的可行性和疗效。方法：12例胫骨慢性骨髓炎患者行胫骨骨髓炎病灶清除、扩大碟形术，取对侧带血管蒂腓骨游离移植，修复患侧胫骨切除后缺损，置冲洗引流管。结果：经2~3年随访，优5例，良6例，中1例，绝大部分病例胫骨碟形化部经重建修复后在13~18月内满意愈合，恢复行走功能，少部分病例术后切口有轻微感染。经随访发现，随着骨缺损部逐渐愈合，移植来的腓骨会逐渐塑形、增粗，并与受区胫骨融为一体。结论：扩大碟形术加带血管蒂腓骨游离移植治疗胫骨慢性骨髓炎具有可行性和较满意之疗效，强调骨髓炎手术适应症的正确把握和感染病灶清除的适当彻底，须注意围手术期全程的规范化管理。 To explore the availability and curative effect of the reconstruction through enlarging sauceriza-tion and Fibula Transplantation with Vascular (FTV) in the cases of chronic tibia osteomyelitis. Methods: Altogether 12 cases of chronic tibia osteomyelitis were treated by massive resection of bone, enlarging saucerization and tibia defects were reconstructed by opposite FTV. Douche and drainage-tube were inserted after operation. Results: The follow-up ranged from 2 to 3 years. Excellent results were obtained in 5 cases, good in 6, fair in 1 case. Mainly cases with tibia enlarging saucerization defects treated by reconstructive repairment were unioned satisfactory after 13 - 18 months. Walk functions were recovered. A few cases were slightly infected in wound. Observing in followed, during the union of bone defects, (ftv) fibula was plastotyped strongly and the fibula and tibia were unioned totally. Conclusions: To treat the chronic tibia osteomyelitis by enlarging saucerization and Free Fibula transplantation with vascular (FTV) should be attached feasible and satisfactory curative effect. To emphasize grasping the operation indication rightly, and the infect focus debridement were cleared suitable thoroughly. The standard administration in whole course of operation should be paid attention.

Stent repair of an anastomotic pseudoaneurysm of the carotid artery after free fibula transplantation

We describe an anastomotic pseudoaneurysm of the carotid artery as a complication after free fibular transplantation. The treatment of choice was endovascular placement of a stent, although this could have occluded the arterial supply to the graft. In our case, the graft remained vital.

Das freie mikrovaskuläre Fibulatransplantat zur Skelettrekonstruktion nach Tumorresektionen am Unterarm - Erfahrungen aus fünf Fällen

Plastic-reconstructive surgery for upper extremity tumors not only follows the fundamental principles of oncologic surgery, but also requires attention to functional and aesthetic aspects. For soft tissue reconstruction, a variety of surgical options are available, whereas for the reconstruction of extensive bony defects only the free microvascular fibular transplant appears to be a reasonable method. Its advantages are its slim shape and variable length, the possibility of achieving a stable osteosynthesis suitable for early physiotherapy, and low donor site morbidity, even if the fibula is harvested as an osteoseptocutaneous flap. Between 1994 and 2000, five patients underwent a free fibula transplantation for radius reconstruction. In all cases, a two-stage reconstructive approach with initial tumor biopsy was chosen. The resected tumors were two osteosarcomas, one extraosseous Ewing sarcoma, one aneurysmatic bone cyst and one desmoplastic fibroma. Surgical and pathohistological tumor-free margins were achieved in all cases (R(0)). Two patients received an osteocutaneous graft. All grafts were revascularized to the radial artery and subcutaneous veins. The transplanted fibula grafts were between 10 cm and 17 cm in length. All proximal osteosyntheses were performed fibuloradially, the distal stabilizations were fibulo-scapho-lunate (2 x) and fibulo-radial (3 x), depending on the extent of resection. All microvascular transplants survived completely and showed a stable osseous integration, both clinically and radiologically. Depending on the postoperative course, an adapted intensive physiotherapy regimen yielded good or satisfactory function. In the follow-up of up to seven years in one case a tumor recurrence (osteosarcoma, 35 months post-operatively) required forearm amputation. The reconstruction of tumor-associated wide bony defects in the upper extremity with a free microvascular fibula graft allows for a successful therapy with respect to oncologic, functional and aesthetic considerations.

Routine donor leg angiography before vascularized free fibula transplantation is not necessary: a prospective study in 120 clinical cases.

To evaluate the value of routine preoperative angiographies of donor sites, 120 patients with free fibula osteoseptocutaneous flap transplantations were included in this prospective study, which consisted of preoperative evaluation of dorsalis pedis and tibial posterior artery pulsation and angiographies of the donor legs (120 patients) and contralateral legs (111 patients). Both pedal pulses were palpable in 114 patients, and only one pulse was palpable in six patients. The respective nonpalpable foot pulses were detectable with pencil Doppler in five patients, but they were not detectable in one patient. Intraoperatively, the latter patient had a relatively hypertrophied peroneal artery as compared with both the tibial posterior and tibial anterior arteries. The angiographic result was arteria peronea magna. The other five patients showed intraoperatively and angiographically normal-sized major arteries of the lower leg. In three patients with normal pedal pulses, hypoplasias of either the tibial anterior or tibial posterior arteries were found intraoperatively. These findings corresponded with the angiographical results. In all patients (n = 119), except one with peroneal artery hemangioma, free osteoseptocutaneous fibula flap was harvested from the originally planned leg without subsequent sequelae to the respective donor leg. In 231 leg angiographies, only 7 cases (3 percent) with abnormalsized major lower leg arteries were described. The diagnoses in these cases were hypoplasia of either the tibial posterior or tibial anterior artery (4 cases), arteria peronea magna (2 cases, one of which was a false positive), absence of peroneal artery combined with hypoplastic tibial posterior artery (1 case), and hemangioma of the peroneal artery (1 case). From this prospective study, it was determined that routine preoperative angiography of the donor leg before fibula transplantation is not justified. It does not add relevant new information about donor leg vascularity, provided that the clinical evaluation of the pedal pulses is well conducted. The only two conditions that may require a preoperative donor leg angiography are abnormal pedal pulses or significant previous lower leg trauma.