Pedicle Graft Research Articles

EComment. Mycotic aortic aneurysms: a real challenge for the cardiac surgeon

We read with great interest the manuscript by Yano et al. regarding the surgical treartment of a mycotic aneurysm of ascending aorta [1]. We agree with the authors that the surgical repair of mycotic aortic aneurysms (extensive debridement of infected tissues, irrigation of the operative field with saline solution or antiseptic fluid and in situ reconstruction of the aorta) combined with wrapping of the prosthetic graft with pedicled omentum and administration of long-term antibiotics for prevention of the recurrence of infection is an acceptable mode of treatment [1]. Rifampicin-bonded prosthetic grafts can offer very good mid-term results. Uchida et al., in their retrospective study of 23 patients with mycotic aneurysms (6in thoracic aorta, 8 in thoracoabdominal aorta and 9 in abdominal aorta), who treated with in situ replacement of aorta with these grafts (plus omental pedicle grafts) found out that the overall survival at 5 years and freedom from aortic events was 95% and 86%, respectively. One patient died in the hospital due to recurrence of infection and another one required reoperation in another site of the aorta [2]. In addition, cryopreserved arterial homografts can be considered the treatment of choice and is our preferred option. Vogt et al., in their retrospective study of 19 patients with mycotic aneurysms (9/19) or infected grafts (10/19), in the thoracic (7/19) or abdominal aorta (12/19), apart from 16.2% mortality (1 early and 2 late deaths) didn't report on any recurrence of infection, homograft problems or anastomotic aneurysms in a mean follow-up period of 18.6 ± 13 months [3]. Silver-coated Dacron grafts compared to cryopreserved arterial homografts are reportable safe and present no significant difference in the treatment of infected abdominal aorta (in early mortality and mid-term survival) [4]. During the last years there is an increased use of thoracic endovascular stents and this modality of treatment has to be considered in the management of the complex cases, but with a higher incidence of recurrent infection. Patel et al., in their retrospective study of 20 patients with endovascular stenting of infected aortic pathological cases including 4 with infected grafts (10 aortobronchial fistulae, 2 aorto-oesophageal fistulae, 1 aortocutaneous fistula and 7 mycotic aneurysms) had an in-hospital mortality of 15%. Arch repair was needed in 8 patients, total descending, in 6 patients. Three patients underwent hybrid thoracic endovascular repair or debranching procedures. Mean Kaplan-Meier survival was 39.0 months. Late mortality was seen in 13 patients (history of immunosuppression and concurrent malignancy in 4 and 5 patients respectively) with 3 related to recurrent infection of thoracic aorta [tendency for recurrence when endovascular stent was performed in an infected graft (p = 0.08)]. At last imaging follow-up, 14 patients had a healed aorta [5]. In conclusion, conventional surgical treatment (with cryopreserved homografts or mycotic resistant prosthetic grafts or omental wrapping) is still the treatment of choice. However, knowing and understanding its limitations, the consideration of endovascular treatment in challenging, high-risk patients may offer acceptable results. Conflict of interest: none declared

Vascularized periosteal graft from the first metatarsal bone: A new technique to prevent collapse of osteonecrosis of the talus in children. A case report

Several microsurgical techniques have been described for the treatment of osteonecrosis of the talus (ONT). Recently reported in children, vascularized periosteal grafts showed promising revascularizing properties. We report a novel technique using a pedicled periosteal graft from the first metatarsal bone to treat steroid-induced early Ficat-Arlet stage III ONT in an 11-year-old boy. The patient presented initial favorable clinical and radiological results which were maintained at 34 months during the last follow-up. Through this original technique, and basing on the powerful osteogenic and vasculogenic propreties of periosteal flaps, we could effectively induce bone revascularization and prevent further collapse of the talar dome.

External coating of colonic anastomoses: a systematic review

Colon anastomotic leakage remains both a frequent and serious complication in gastrointestinal surgery. External coating of colonic anastomoses has been proposed as a means to lower the rate of this complication. The aim of this review was to evaluate existing studies on external coating of colonic anastomoses. CINAHL, EMBASE, and PubMed were searched up to September 2011 to identify studies evaluating external coating of colonic anastomoses. Forty studies have evaluated 20 different coating materials, of which only fibrin sealant, omental pedicle graft, and hyaluronic acid/carboxymethylcellulose have been used in humans. Fibrin sealant has shown positive, however not significant, results. Omental pedicle graft can be used safely, yet without beneficial effects, whereas hyaluronic acid/carboxymethylcellulose should be avoided due to increased complications. The remaining coating materials have solely been evaluated in experimental animals with many contradictory and few positive results. External coating of colonic anastomoses has yet failed to show convincing results. Randomized clinical trials and high-quality experimental studies are warranted to determine the role of fibrin sealant, omental pedicle graft, and other coating materials for prevention of colon anastomotic leakage.

Applicability of buccal fat pad grafting for oral reconstruction

This study evaluated the applicability of pedicled buccal fat pad grafting for the reconstruction of defects surgically created during oral surgery. A buccal fat pad graft was applied in 23 patients (5 males, 18 females; mean age 68.3 years) between 2003 and 2011. The graft was used to cover surgical defects of the palate, maxilla, upper gingiva, buccal mucosa, lower gingiva, oral floor, and temporomandibular joint region. Size of the surgical defects ranged from 15mm×12mm to 30mm×40mm; size of the buccal fat pad ranged from 15mm×12mm to 43mm×38mm. A pedicled buccal fat pad was prepared by incising the maxillary vestibule following primary surgery, and the surrounding connective tissue was preserved to supply nutrition to the pedicle during surgery. The buccal fat pad was placed on the raw surface of soft tissue or bone surface and sutured to the surrounding tissue of the defect. Complete epithelialization was observed within 4 weeks postoperatively. There were no complications or functional disorders during follow-up. Buccal fat pad grafting appears to be feasible for the reconstruction of surgically induced defects, and can be extended to the palate, mandible, mouth angle, and temporomandibular joint region.

USE OF TECHNOLOGIES OF PLASTIC AND RECONSTRUCTIVE MICROSURGERY IN TREATMENT OF PATIENTS WITH PATHOLOGY OF THE SHOULDER JOINT

Objective: 9 patients with sequela of serious injuries and burns of the shoulder joint region operated in Vreden’s Scientific Research Institute of traumatology and orthopaedics (Saint-Petersburg, Russia) within the period from 2000 to 2011. Methods: 12 microsurgical operations having used 12 flaps were performed. In 10 cases it was pedicled flap transfer, in 2 cases - free tissue transfer. Patients with defects of bones have been additionally fulfilled 4 operations of shoulder arthrodesis and 2 operations of interlocking intramedullary nailing of proximal humerus. The results of treatment were estimated according to modified UCLA end-results score. Results: for reconstruction of isolated scar deformations and defects of skin in the shoulder joint region in 6 cases we used pedicled latissimus dorsi musculocutaneous flaps, in 1 case - pedicled trapezius musculocutaneous flap, and in 1 case - free radial forearm flap. In cases of shoulder arthrodesis we used pedicled latissimus dorsi osseous musculocutaneous flap with a segment of the 8th rib and free vascularized graft of iliac bone in patients with defects of bones. In two patients with circular defects of proximal humerus we fulfilled osteoplasty of the area of contact of fragments with pedicled grafts from the lower corner of scapula. 4 patients with scar contractures of shoulder-joint had excellent results, others had good results. Conclusion: tactics of using microsurgical technologies and choice of flaps in patients with pathology of shoulder-joint region should be specified for every concrete occasion. Microsurgical operations form an important part of the system of surgical treatment and are usually fulfilled simultaneously with other orthopedic operations.

A pedicled autologous choroid RPE patch: a technique to preserve perfusion.

The aim of the study is to report a technique of a pedicled autologous choroid retinal pigment epithelium (RPE) patch that aims to preserve perfusion of the transplanted tissue. A case report of a patient with sudden vision deterioration due to submacular hemorrhage in age-related macular degeneration. The surgery involved a 180-degree peripheral retinectomy and the creation of a pedicled graft instead of an isolated one. Outcome measures included preoperative and postoperative visual acuity and optical coherence tomography scans at 1, 3, 6, 12 months and patch vascularization on postoperative indocyanine green angiography. Postoperatively the patch was positioned under the fovea with an intact pedicle. Indocyanine green angiography showed perfusion through the pedicle and patch vasculature on the third postoperative day. Best corrected visual acuity improved from 0.5/50 to 5/50 at 1 month and remained stable over 1 year follow-up. No choroidal neovascularization recurrence was observed. This case report demonstrates the feasibility of a pedicled RPE-choroid graft that is an alternative to a free isolated graft. Our modification of patch surgery, by demonstrating early perfusion, offers an advantage, similar to macular translocation, when photoreceptors are embedded in RPE and choroid with blood circulation immediately after the surgery.

Jejunal Pedicle Graft Reconstruction of the Esophagus in a Child with Tracheal Agenesis

Jejunal Pedicle Graft Reconstruction of the Esophagus in a Child with Tracheal Agenesis

Effect of tissue engineering small vessel scaffolds in experimental animals

Acellular xenogeneic small vessel scaffolds preliminarily eliminate the xenogeneic antigen that could induce an immune rejection. We transplanted the Wistar rat caudal artery scaffolds into Japanese white rabbit ear central arteries, and observed the changes of blood flow and vessel wall. We acquired 30 caudal arteries from 15 Wistar rats, some were directly assigned as caudal artery group, the others were disposed by 1% p-octyl polyethelene glycol phenyl ether, and were assigned as the group of tissue engineered small vessel scaffold. We collected 15 Japanese white rabbits, and utilized a pair of ear central arteries per rabbit as hosts. Through microscopic surgery, the proximal broken end of central artery was overlapped into the donor’s proximal vessel lumen by sleeve anastomosis, while the distal broken end was sutured by classical end-to-end anastomosis. The maximum patency time of small vessel scaffold was 46 hours and 47 minutes, and which of caudal vessel was 14 hours. The poor blood flow primarily was occurred in distal broken end, while proximal end was connected in pedicle graft structure. On the 10th day, tunica intima fibers in vessel scaffold were still arranged in cylindrical conformation regularly without cell adherence. On the 100th day, tunica intima fibers were still preserved completely in proximal end. The results showed that xenogeneic acellular small vessel scaffold can be transplanted into the host, and the sleeve anastomosis was significantly superior to the classical end-to-end anastomosis.

Coronoidectomy, masticatory myotomy and buccal fat pad graft in management of advanced oral submucous fibrosis

The purpose of this study is to evaluate coronoidectomy, masticatory myotomy and buccal fat pad graft in advanced (Stage III–IV) oral sub mucous fibrosis (OSF). 10 patients with clinically and histologically confirmed advanced OSF underwent surgery entailing bilateral coronoidectomy, masticatory muscle myotomy and closure with a pedicled buccal fat pad graft followed by vigorous mouth opening exercises. The result was evaluated using the interincisal distance at maximum mouth opening as the objective outcome measure over a follow up period of 12 months. Results showed a mean interincisal opening of 14.7mm preoperatively and 32.5mm at 12 months postoperatively. Relapse was encountered in one patient who did not cooperate with the postoperative exercise regime. Results suggest this regime is effective.

Long-term angiogenic activity of free grafts and pedicle flap in a rabbit urethroplasty model

We studied the late angiogenic activity of free grafts and a pedicle flap in a rabbit urethroplasty model to determine whether angiogenic activity plays a role in late outcomes of urethral reconstruction in rabbits. Twenty-eight rabbits were randomly divided into five groups according to the method used to bridge a urethral defect as an onlay patch: Control, simple closure of urethral defect (Group O1); free penile skin graft (FPSG, Group A1); buccal mucosal graft (BuMG, Group B1); bladder mucosal graft (BlMG, Group C1); and pedicle penile skin flap (PPSF, Group D1). Angiogenic activity of the patch on postoperative day 84 was assessed by immunohistochemistry. The angiogenic activity in Groups O1, A1, B1, C1, and D1 was 23.33 ± 4.92 (means ± SD), 42.89 ± 6.52, 55.78 ± 3.46, 53.61 ± 6.17, and 24.11 ± 9.07 vessels per optical field, respectively. There were statistically significant differences (p < .001) between Group O1 and A1 B1, C1, Group A1 and B1, C1, D1, Groups B1 and D1 and Groups C1 and D1, but not between Groups O1 and D1 (p = 1.000) and Groups B1 and C1 (p = .872). The long-term angiogenic activity of all the groups was significantly lower (p < .001) than in the corresponding early groups. Although the angiogenic activity of all the groups decreased in the late assessment, the buccal mucosal graft continued to exhibit elevated angiogenesis above bladder or skin (free or pedicle) graft. Therefore, buccal mucosal patch graft might be preferable because of its easier harvesting.

PERIOSTEAL PEDICLE GRAFT: A PROMISING TECHNIQUE FOR THE TREATMENT OF GINGIVAL RECESSION DEFECTS

The periosteum is a rich vascular connective tissue with great regenerative potentiality. The qualities of periosteum make it an ideal autogenous graft. The present case report describes the utilisation of periosteal pedicle graft for the treatment of gingival recession defect successfully.

Comparison of periosteal pedicle graft and subepithelial connective tissue graft for the treatment of gingival recession defects

The use of periosteum as a pedicle graft in the treatment of gingival recession defects is a recent advancement. The subepithelial connective tissue graft (SCTG) is considered the gold standard for the treatment of gingival recession defects. The present randomized controlled trial was done to compare periosteal pedicle graft (PPG) with SCTG for the treatment of gingival recession defects. 10 males and 10 females between the ages of 16 and 40 years (mean age 25.2 years) with Miller's Class I and II recessions ≥3 mm participated in this one-year clinical study. They were assigned randomly to test group (PPG) and control group (SCTG). Results were evaluated based on parameters measuring patient satisfaction and clinical outcomes associated with two treatment procedures. Significance was set at p < 0.05. At the end of the study, the defect coverage was 3.1 ± 0.13 mm or 92.6% in the test group compared to the control group in which the defect coverage was 2.70 ± 0.11 mm or 88.5%. The difference between the two groups was statistically significant (p < 0.0001). The average residual defect was comparable between the two groups, i.e. 0.3 ± 0.67 and 0.5 ± 0.84 in the PPG and SCTG group respectively. The test group was rated higher in terms of overall patient satisfaction (p < 0.02) and comfort during and after the procedure (p < 0.001). PPG and SCTG have comparable clinical effectiveness, but PPG is superior to SCTG in terms of patient-centred outcomes, reflecting improved patient comfort and overall patient satisfaction.

Invited Commentary

Mycotic aneurysms of the aorta are relatively rare and compose only 1% of all thoracic and abdominal aortic aneurysms [1Brown S.L. Busuttil R.W. Baker J.D. et al.Bacteriologic and surgical determinants of survival in patients with mycotic aneurysms.J Vasc Surg. 1984; 4: 541-547Google Scholar, 2Muller B.T. Wegener O.R. Grabitz K. et al.Mycotic aneurysms of the thoracic and abdominal aorta and iliac arteries: experience with anatomic and extra-anatomic repair in 33 cases.J Vasc Surg. 2001; 33: 106-113Abstract Full Text Full Text PDF PubMed Scopus (464) Google Scholar]. They are caused by a bacterial infection of the wall of the artery, leading to aneurysm formation, emboli, and rupture. Patients usually present with fever, pain, and leukocytosis. Treatment is usually bimodal with intensive antibiotic therapy as well as surgical repair. Traditional principles of surgical therapy consist of resection of the aneurysm, wide debridement, and reconstruction with an in situ graft when suprarenal and an extraanatomic bypass when the aneurysm is infrarenal [1Brown S.L. Busuttil R.W. Baker J.D. et al.Bacteriologic and surgical determinants of survival in patients with mycotic aneurysms.J Vasc Surg. 1984; 4: 541-547Google Scholar, 2Muller B.T. Wegener O.R. Grabitz K. et al.Mycotic aneurysms of the thoracic and abdominal aorta and iliac arteries: experience with anatomic and extra-anatomic repair in 33 cases.J Vasc Surg. 2001; 33: 106-113Abstract Full Text Full Text PDF PubMed Scopus (464) Google Scholar]. Using this approach, in-hospital mortality is as high as 36%, although infrarenal aneurysms have a better outcome than do aneurysms in the suprarenal position (including the thoracic aorta). In the present article, Uchida and colleagues [3Uchida N. Katayama A. Tamura K. Miwa S. Masatsugu K. Sueda T. In situ replacement for mycotic aneurysms on the thoracic and abdominal aorta using rifampicin-bonded grafting and omental pedicle grafting.Ann Thorac Surg. 2012; 93: 438-442Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar] report on 23 patients in whom they used an in situ graft reconstruction with a rifampin-bonded graft in all patients and an additional omental wrap in half the patients. The overall results are very good. They achieved eradication of infection in 22 of 23 patients and had an impressive 95% survival at 5 years. Yes, these are small numbers and there is case selection, but this is a rare problem and extensive trials will not be forthcoming. This article has 2 interesting features that could be of use to all of us when faced with an infected aneurysm: (1) As previous case reports have suggested, a rifampin-impregnated graft may be implanted successfully in an infected field [4Lachapelle K. Graham A.M. Symes J.F. Antibacterial activity, antibiotic retention, and infection resistance of a rifampin-impregnated gelatin-sealed Dacron graft.J Vasc Surg. 1994; 19: 675-682Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar, 5Gupta K. Bandyk D.F. Johnson B.L. In situ repair of mycotic abdominal aortic aneurysms with rifampin-bonded gelatin-impregnated Dacron grafts: a preliminary report.J Vasc Surg. 1996; 24: 472Abstract Full Text Full Text PDF PubMed Scopus (67) Google Scholar]. (2) Omental coverage may provide lasting protection from graft reinfection. Of course it is impossible to ascertain the additional role of the omentum to a rifampin-bonded graft, but we know it can be quite effective [6Kuniyoshi Y. Koja K. Miyagi M. et al.Graft for mycotic thoracic aortic aneurysm: omental wrapping to prevent Infection.Ann Asian Cardiovasc Thorac. 2005; 13: 123-128Google Scholar]. If possible we should cover the graft with omentum. Although not addressed in this article, the role of endovascular repair for mycotic aneurysms appears to be growing [7Sörelius K. Mani K. Björck M. Nyman R. Wanhainen A. Endovascular repair of mycotic aortic aneurysms.J Vasc Surg. 2009; 50: 269-274Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar]. However placing prosthetic material into an infected space seems counterintuitive. It may not work well in the long run. In Situ Replacement for Mycotic Aneurysms on the Thoracic and Abdominal Aorta Using Rifampicin-Bonded Grafting and Omental Pedicle GraftingThe Annals of Thoracic SurgeryVol. 93Issue 2PreviewThe objective of this report is to discuss the efficacy of in situ replacement for treating mycotic aneurysm, particularly using rifampicin-bonded grafts and omental pedicle grafts, on the basis of our 7 years of experience. Full-Text PDF

6 Year patency of the radial artery graft to the right coronary artery. Influence of positioning the radial artery pedicle

Objectives: The supporting veins and the fascia in the pedicled radial artery graft provide stability but restrict length and thus can cause kinking of the artery when the unflexible fascia is placed on the outer curvature of a bend. Especially when bypassing the right coronary artery, the graft is predisposed to kink over the acute margin of the heart.

The Use of Buccal Fat Pad in the Treatment of Oral Submucous Fibrosis: A Newer Method

Purpose of the study. This study was to evaluate the use of buccal fat pad as an interpositioning material in surgical management of oral sub mucous fibrosis. Materials and methods. A series of 8 cases with proven oral sub mucous fibrosis, with mouth opening less than 20 mm, involving the buccal mucosa were treated surgically in the Department of Oral and Maxillofacial Surgery, College of Dental Surgery, Saveetha University, Chennai. Pedicled buccal fat pad was used as an interpositioning material to cover the raw areas in the oral cavity after incision and release of fibrous bands. Results. In 8 patients, the range of pre operative mouth opening was 3–18 mm (mean 14 mm). As the result of the successful surgical procedure, the size of the intra operative mouth opening was ranged from 25–38 mm (mean 33.25 mm). The patients were discharged 5–7 days after the operation. The range of the mouth opening at this time was 25–36 mm (mean 30.63 mm). The results were evaluated using student's t test and found to be statistically significant. The pedicled grafts took up uneventfull.

Translocated Pedicled Buccal Fat Pad

Problem of closure of skull base defects after removal of craniobasal lesions, especially, craniofacial, is one of the most challenging in neurosurgery. Persistent skull base defect produces extremely high risk of cerebrospinal fluid leaks and consecutive infectious complications. Local pedicled grafts are the preferred material for plasty. In this study, the authors present original technique of using a pedicled buccal fat pad (BFP) graft. Anatomy and functions of BFP are discussed in details as well as surgical technique illustrated by 2 case reports. From 2004 to 2010, 188 patients with anterior and middle skull base mass lesions were operated on in Burdenko Neurosurgical Institute (Moscow, Russia) using BFP as plastic material for closure of different defects (male-female ratio=61:127; mean age was 47 years [range, 10-74 years]). In 93.6% of cases, pedicled BFP flap was applied; in 6.4%, free flap was used. Follow-up period ranged between 1 and 7 years. Only 1 case of postoperative cerebrospinal fluid leak was observed; flap rejection was not registered in the series. High effectiveness and minimal invasiveness are principal advantages of the described technique, which is applied in neurosurgery for the first time. Other benefits include proximity of donor site and defect, simplicity of surgical technique, minimal postoperative discomfort, and very low risk of benign complications.

Pseudarthrosis of femoral neck stress fracture treated with open reduction, sliding hip screw and bone morphogenic protein

INTRODUCTIONPseudarthrosis of femoral neck stress fractures in young adults are associated with a high incidence of complications and revision surgery. The majority are treated urgently with closed reduction and internal fixation. PRESENTATION OF CASEWe describe a displaced tension-type femoral neck fatigue fracture presenting late. Pseudarthrosis formation prior to surgery resulted in resorption and shortening of the femoral neck. Open reduction and internal fixation was performed, with adjuvant recombinant human bone morphogenic protein-7 therapy. Radiological union was achieved by twelve weeks and by one year the patient was asymptomatic. DISCUSSIONReports of successful management of femoral neck fatigue fracture non-unions are rare. Meyer's muscle pedicle graft, valgus subtrochanteric osteotomy, and cannulated screw fixation with autologous iliac crest bone graftare alternative procedures. CONCLUSIONThis extremely rare fracture type merits open reduction to enable accurate fracture reduction. Supplementing sliding hip screw fixation with an orthobiological agent was successful in this challenging situation.

Role of Periosteal Pedicle Graft as an Autogenous Guided Tissue Membrane in Periodontal Regeneration: An Ethical Perspective

Role of Periosteal Pedicle Graft as an Autogenous Guided Tissue Membrane in Periodontal Regeneration: An Ethical Perspective

In Situ Replacement for Mycotic Aneurysms on the Thoracic and Abdominal Aorta Using Rifampicin-Bonded Grafting and Omental Pedicle Grafting

The objective of this report is to discuss the efficacy of in situ replacement for treating mycotic aneurysm, particularly using rifampicin-bonded grafts and omental pedicle grafts, on the basis of our 7 years of experience. Between December 2003 and December 2010, we performed surgical treatments in 23 patients (for the thoracic aorta in 6 patients, for the thoracoabdominal aorta in 8 patients, and for the abdominal aorta in 9 patients; 7 emergency, 10 urgent, and 6 elective operations) with mycotic aneurysm by using rifampicin-bonded grafting and omental pedicle grafting. One patient died in hospital because of local recurrent infection. One patient required an additional operation on another aortic site, and 3 patients had spinal cord injuries (2 transient and 1 permanent). Overall survival at 5 years was 95%, and the rate of freedom from aortic events at 5 years was 86%. In situ replacement using rifampicin-bonded grafting and omental pedicle grafting is effective for treating mycotic aneurysms of the thoracic and abdominal aorta.

Osteosynthesis of femoral-neck nonunion with angle blade plate and autogenous fibular graft

Revision internal fixation for femoral-neck nonunion is a challenging procedure. Treatment options are osteotomy, osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularised or nonvascularised fibular graft) or arthroplasty. The objective of this article is to report the outcome of revision internal fixation using an angle blade plate and autogenous fibular graft in symptomatic aseptic femoral-neck nonunion. Twenty-two patients who had been treated previously with cannulated screws or dynamic hip screw for femoral-neck fracture and progressed to nonunion were treated with revision internal fixation using an angle blade plate and autogenous nonvascularised fibular graft. Mean patient age was 38 (range 21-52) years, with average duration between injury and revision surgery 11.2m (range 8-16 months). Other than one nonunion, we achieved union in all patients (21 patients, 91%) after an average period of 4.4 months. The functional outcome after 3.2 years as per scoring system given by Nagi et al.. showed excellent results in four, good in ten, fair in six and poor in two patients. Patients with poor results included one with nonunion and other with avascular necrosis with collapse of the femoral head. Average limb shortening was 1.5 cm, and mean femoral-neck-shaft angle was 116°. There was no instance of fibular graft fracture, slippage or implant cut-through. Angle blade plate provides rigid stability and offloads any shearing force over the fibular graft when used for revision internal fixation in aseptic femoral-neck nonunion. Thus, the fibular graft only serves the purpose of osteogenesis and stimulates the surrounding host cells to promote healing at the nonunion site. We recommend the angle blade plate and autogenous fibular graft as a viable option for hip-joint salvage in revision internal fixation of aseptic femoral-neck nonunion.