Vascularized Fibular Bone Graft Research Articles

Treatment for Calcaneal Osteomyelitis with Pseudoarthrosis with a Vascularized Fibula Bone Graft and Autologous Cancellous Bone Graft: A Case Report

Calcaneal osteomyelitis with pseudarthrosis after calcaneal fracture is rare, and its treatment is challenging. We describe the use of a free fibular osteocutaneous flap to treat a 52-year-old man who presented with calcaneal osteomyelitis and pseudarthrosis after an operation for a closed comminuted fracture. The patient was previously treated with multiple surgeries and antibiotics for 8 months, but he was not cured. We performed radical osteomyelitis bone debridement and reconstruction with a free fibular osteocutaneous flap and autotrabecular bone grafting from the iliac crest. The skin flap survived, and rehabilitation was initiated early. At 2 years postoperatively, his pain and ambulatory function had markedly improved, and he could walk without problems in daily life. Free fibular osteocutaneous flap and autogenous cancellous bone grafting are considered practical options for the treatment of calcaneal osteomyelitis with pseudarthrosis.

Vascularized fibular flap and custom-made synthesis in post-traumatic ulnar diaphyseal pseudarthrosis: a case report

BackgroundAlthough isolated fractures of the ulnar shaft are considered common and relatively benign injuries, numerous complications can arise especially in the context of suboptimal care pathways. For pediatric patients, however, there is no single indication of the surgical approach. In the context of the management of these complications, it is known that the vascularized fibular graft has numerous advantages and indications in the treatment of recurrent pseudarthrosis. However, in revision surgery the frequent occurrence of anatomical subversions requires the use of fixation means adapted to the individual patient. We present a clinical case of an adult patient suffering from post-traumatic ulnar pseudarthrosis treated with autologous vascularized fibula grafts and 3D-planned custom-made plate.Case presentationA 38-year-old Ivorian woman came to our attention with a painful nonunion of the ulnar shaft and significant dysmorphism of the left forearm, with shortening and flexion of the limb as an outcome of unspecified road trauma in childhood. No alterations of the nerve compartment were reported. As far as detectable, she had undergone autologous bone grafting and implantation of questionable synthetic means, without acute treatment. Since we evaluated the patient (2012), we have performed two debridement surgeries, associated with autologous avascular bone graft from the iliac crest and plate fixation (2012 and 2014). In both cases, rupture of the fixation media was observed. In 2021, the pseudarthrosis was treated with a vascularized fibular bone graft. The subverted radius and ulna anatomy and poor bone quality required patient-specific reconstruction of the pseudarthrosic ulna from a 3D scan and the production of custom-made plate and screws, supported by the creation of special guides for drilling and by optimizing the positioning of screws with preoperative digital models. In the postoperative period, regular follow-up visits with X-rays evaluations were performed at 1, 3 and 6 months after surgery. No inflammatory reactions or local rejection were found. The fibula graft healed at the proximal ulnar junction six months after the operation while it took eight months to heal at the distal junction. Functionally, we observed a pain reduction and a range-of-motion preservation.ConclusionsThe multiple failures of diaphyseal reconstruction with avascular bone grafts have forced the indication to the vascularized fibular flap. This case is a unique experience but we believe that the association between vascularized bone graft and the potential for customization through 3D planning represents a valid surgical potentiality in complex cases of post-traumatic reconstruction.

Treatment of Refractory Congenital Pseudoarthrosis of Tibia with Contralateral Vascularized Fibular Bone Graft and Anatomic Distal Tibial Locking Plate: A Case Series and Literature Review

Congenital pseudoarthrosis of the tibia (CPT) remains a challenge for physicians. Several treatment options have been proposed, but the standard of care remains inconclusive. In this study, we present three patients for whom the failure of prior treatments was managed with a contralateral vascularized fibular bone graft (VFG) and an anatomic distal tibial locking plate. Between 2017 and 2021, three patients were referred for failed treatment of CPT. All patients had undergone multiple prior surgeries, including tumor excision and fixation with ring external fixators, plates, and screws. We performed radical tumor resection and reconstruction of bone defects with a VFG. The construct was fixed with an anatomic locking plate, and the patients were followed up for a mean of 45.7 months. All three patients were able to obtain graft union at 19.3 weeks. At the final follow-up, all grafts achieved bony hypertrophy without evidence of bone resorption or local tumor recurrence. There was a mean leg length difference of 8.5 cm preoperatively, compared with 6.3 cm postoperatively. The average lower leg angulation was 7.4 degrees and the average ankle range of motion was 58.3 degrees. The mean VAS score was 0 and the mean AOFAS score was 88.3. No significant complications were noted. Implantation of a VFG and an anatomic distal tibia locking plate can be considered an option for treatment-refractory CPT. Patients can expect to achieve bone consolidation, ambulate as tolerated, and have a low complication rate.

What is the Cumulative Incidence of Revision Surgery and What Are the Complications Associated With Stemmed Cementless Nonextendable Endoprostheses in Patients 18 Years or Younger With Primary Bone Sarcomas About the Knee.

Osteosarcoma and Ewing sarcoma are more common diagnoses in preadolescent and adolescent children compared with the adult population. A greater percentage of patients are treated with limb salvage and reconstruction using modular tumor endoprostheses. Implant-to-bone fixation can be cemented or cementless. Cementless tumor endoprostheses rely on biologic osteointegration for implant stability, and chemotherapy during childhood and adolescence can disturb the bone turnover rate and reduce bone mineral density, which in turn may predispose patients with uncemented endoprostheses to a high rate of revision surgeries. (1) What is the cumulative incidence of revision operations for any cause (wound dehiscence, periprosthetic fracture, hinge breakage, aseptic loosening, infection, local recurrence, implant removal, and amputation) of cementless tumor endoprostheses around the knee? (2) What is the cumulative incidence of aseptic loosening, periprosthetic fracture, hinge breakage, and infection, and what proportion of patients had other complications? (3) What was the mean limb length discrepancy (LLD) at the time of skeletal maturity? (4) What was the median Musculoskeletal Tumor Society (MSTS) score at most recent follow-up or just before implant removal/amputation if implant removal/amputation were performed? Between 2008 and 2019, we treated 328 patients younger than 18 years for a primary bone sarcoma around the knee at our institution. Of those, 138 were treated with resection and reconstruction using two different types of modular tumor endoprostheses. During this period, our general indications for an endoprosthesis were patients who were candidates for an intraarticular resection of the distal femur or proximal tibia and who were at least 10 years of age. Uncemented fixation was always preferred. Cemented fixation was only done when intraoperative press-fitting of a cementless stem was not possible. Among uncemented implants, 26 patients died before completing 2 years of follow-up with intact implants and without further surgery, three were lost to follow-up before 2 years, and four patients received implants as a secondary salvage surgery after a failed primary biologic reconstruction with a vascularized fibular bone graft, leaving 94 patients for evaluation in this retrospective study. The mean age was 15 ± 2 years and the median (interquartile range) follow-up duration was 51 months (39 to 74). We did a competing risks analysis to tally cumulative incidence of all-cause revision procedures and cumulative incidence of aseptic loosening, periprosthetic fracture, hinge breakage, and infection. Other complications, including wound dehiscence, local recurrence, and stem breakage, were characterized descriptively and ascertained by review of electronic records of a longitudinally maintained institutional database by the treating surgeons. LLD was measured by serial clinical assessments and CT scans, starting since primary salvage surgery and until the latest follow-up of every patient. For the analysis of remaining LLD, we included only patients who were skeletally immature at time of primary resection and who had reached skeletal maturity by their latest follow-up (73% [69 of 94]). Functional outcome was assessed using MSTS scores obtained from a review of electronic records of a longitudinally maintained institutional database. The 8-year cumulative incidence of revision surgery for any cause was 32% (95% confidence interval 23% to 42%). The 8-year cumulative incidence of aseptic loosening was 5% (95% CI 2% to 11%), periprosthetic fracture was 9% (95% CI 4% to 15%), hinge breakage was 19% (95% CI 12% to 28%), and infection was 7% (95% CI 3% to 14%). Other complications included wound dehiscence in 2% (2 of 94), stem breakage in 2% (2 of 94), and local recurrence in 2% (2 of 94) of patients. Stress shielding of the cortical bone around implanted stems was observed in 26% (24 of 94). The mean LLD for those who were skeletally immature at the time of primary resection and who reached skeletal maturity was 3.5 ± 2.6 cm. At latest follow-up, the median (IQR) MSTS score for all patients, excluding those who had complete implant removal or amputation, was 26 (24 to 27) of a maximum score of 30. We observed a high rate of early revision and relatively frequent complications associated with the use of cementless fixation, and although this was not a comparative study, the findings were not superior to those reported by others who have studied cemented fixation for this indication. Furthermore, there may be some disadvantages with cementless fixation, such as stress shielding. Comparative studies about fixation methods are needed. The prevalence of bushing breakage in the current study highlights the importance of future modifications in the hinge design of both types of prostheses used in this study. Patients who were skeletally immature at the time of primary surgery had a LLD no more than 5 cm at skeletal maturity; consequently, nonexpandable endoprostheses may be appropriate for some adolescent patients who have limited remaining growth, although which patients are best suited for this approach would require specific study. Level IV, therapeutic study.

One bone forearm with vascularized fibular graft. Clinical experience and literature review

One-Bone-Forearm (OBF) is a procedure in which the proximal stump of the ulna is fixed to the distal stump of the radius. Historically, the indications for OBF have been represented by forearm instability due to trauma, infection, tumor resection, and congenital deformities with severe radius and ulna bone loss. When major bone loss prevents direct fixation between ulna and radius a Vascularized Fibular Bone Graft (VFBG) may allow forearm bone reconstruction and fixation. In this study we report our clinical experience in 4 cases of OBF with VFBG performed in 3 patients. Compared to standard OBF technique with direct osteodesis, OBF with VFBG showed similar clinical results and high rate of healing even in case of bone infection. Moreover, composite osteocutaneous VFBG might concurrently allow to treat local soft tissue defects.

Reconstruction of extremity long bone defects with vascularized fibula bone grafts

Reconstruction of extremity long bone defects with vascularized fibula bone grafts

Three-stage treatment protocol for recalcitrant distal femoral nonunion.

In this study, we proposed a three-stage treatment protocol for recalcitrant distal femoral nonunion and aimed to analyze the clinical results. We retrospective reviewed 12 consecutive patients with recalcitrant distal femoral nonunion undergoing our three-stage treatment protocol from January 2010 to December 2014 in our institute. The three-stage treatment protocol comprised debridement of the nonunion site, lengthening to eliminate leg length discrepancy, deformity correction, stabilization with a locked plate, filling of the defect with cement spacer for inducing membrane formation, and bone reconstruction using a cancellous bone autograft (Masquelet technique) or free vascularized fibular bone graft. The bone union time, wound complication, lower limbs alignment, amount of lengthening, knee range of motion, and functional outcomes were evaluated. Osseous union with angular deformity <5° and leg length discrepancy <1cm were achieved in all the patients. The average amount of lengthening was 5.88cm (range 3.5-12cm). Excellent or good outcomes were obtained in 9 patients. Although the current study involved only a small number of patients and the intervention comprised three stages, we believe that such a protocol may be a valuable alternative for the treatment of recalcitrant distal femoral nonunion.

Clinical and Functional Outcomes of Implant Prostheses in Fibula Free Flaps

ABSTRACT Introduction Functional reconstruction of jaw defects due to surgical resection is a challenge in maxillofacial surgery. The fibula free flap in combination with dental implants has exhibited growing popularity for such reconstructions. This study aimed at evaluating the clinical and functional outcome of dental implants inserted in fibula free flaps and dental implants used for orofacial reconstruction following ablation of tumors. Materials and methods A clinical follow-up study of 10 patients was conducted after oral surgery, who received vascularized fibula bone grafts and endosseous implants for functional jaw reconstruction during a 12-year period. The follow-up protocol included a clinical examination and radiological evaluation and interview using a questionnaire. Information on postoperative recovery after the surgical reconstruction phase and implant placement, type of diet, swallowing problems, speech intelligibility, lip competence, and perceived facial appearance was collected and analyzed. Results The survival rate of fibula free flap was 100%. The survival and success rates of implants placed in the fibula flaps at the end of the follow-up period were 100 and 94% respectively. Conclusion Implants placed in fibula bone grafts have been shown to integrate normally. Surgical reconstruction with vascularized fibula bone grafts followed by placement of dental implants after jaw resection can provide good clinical and functional outcomes for oral rehabilitation with a prosthesis. How to cite this article A riga P, N arayanan V, J ain A R, Philip JM, Nathan S. Clinical and Functional Outcomes of Implant Prostheses in Fibula Free Flaps. World J Dent 2017;8(3):171-176.

Early Vascularized Fibular Grafts in Infants with Congenital Pseudarthrosis.

Neurofibromatosis type I, also known as Von Recklinghausen disease, is one of the most common congenital disorders, with an incidence of 1 out of 3,000–4,000. It can be diagnosed on the basis of characteristic phenotypic manifestations, such as cafe-au-lait spots, axillary and inguinal freckling, neurofibromas, optic gliomas, Lisch nodules and distinctive osseous lesions. Osseous lesions occur in 2%–3% of neurofibromatosis type I cases, and are known to be caused by a lack of osteoblast function and the consolidation of osteoclast activity [1]. The most commonly affected region is the diaphysis of the tibia. Due to segmental disturbances in periosteal bone formation, anterior bowing occurs, and pathologic fractures eventually develop. In the first 2 years of life, pseudarthrosis may occur, which makes bone healing difficult due to persistent instability and progressive deformity in the bone. In patients with congenital pseudarthrosis, serious consequences such as amputation of the lower limb may be necessary if the condition is not adequately managed [2]. In this report, the authors describe the case of a vascularized fibular bone graft in a congenital pseudarthrosis patient.

Free Vascularized Fibular Bone Graft for Treatment of Difficult Cases of Infected Nonunion of Both Forearm Bones

Objective: The treatment of infected non-union both bone forearm is considered as challenge orthopaedic procedure. Infection should be eradicated, non-union should be treated meticulously with debridement, removal of necrotic bridging tissue. Vascularized fibula bone graft is considered as the best solution to bridge the defect and eradicate the infection. Methods: Twenty-four patients (16 men and 8 women), who formed the basis of the study, underwent surgery in the Hand and Microsurgery Unit, Sohag University, from January 2008 to January 2015. The right side was involved in 11 cases and the left side in 13 cases. Average age was 35.2 years. The causes of bone defects were infected nonunion of both bone forearms in 10 cases, infected nonunion of the middle part of radius in 7 cases, post-traumatic bone loss of distal radius in 4 cases (aneurysmal bone cyst in 1 and osteosarcoma in 2 patients). The principle of treatment was debridement and excision of either infected unhealthy bone or tumor tissues with wide safety margin. The average bone defect was 8 cm (range, 6-14 cm). The defect was bridged by osteoseptocutaneous vascularized fibular bone graft. The donor bone was the right fibula in 10 cases and the left fibula in 14 cases. Two grafts were used in 1 patient because of soft tissue injuries, which included the peroneal vessels during osteotomy. The vascularized fibula was fixed by small dynamic compression plate. The operative time ranged between 7 and 11 hours. Blood transfusion was indicated in all the cases and its average transfusion was 1000 mL. Results: The average follow-up was 84 months. Bone union was ultimately obtained in 22 patients except 2 who had failure of the graft. Arthrodesis of the distal ulna with the wrist joint was done during the follow-up. Arthrodesis of the wrist joint was also performed for 1 patient who had loss of carpal bones, distal radius, and wrist and finger extensors. The average time for union was 3.5 months. The hand function was normal in all cases. Stress fracture and fibular donor-site morbidity did not occur in this series. Neither shoulders nor elbows were affected postoperatively. There was no recurrence for either infection or tumor. Conclusion: We recommend free vascularized fibula bone graft for treatment of difficult cases of infected non-union both bone forearm not only to restore the anatomy but also to obtain nearly normal hand function.

Free Vascularized Fibular Bone Graft, a Reliable Method for the Management of Large Skeletal Defects in Orthopaedic Trauma

Introduction: Free vascularized fibular bone grafts have become the most commonly used free vascularized bone grafts used to treat large post-traumatic defects caused by high-energy trauma, as well as large post-traumatic nonunions. Material and methods: We present two high energy trauma cases: a traumatic amputation of the forearm – 22C3 open Gustilo-Anderson type IIIC (case 1) with a 10 cm residual radial shaft defect and a paragliding accident resulting in a 43C3 open Gustilo-Anderson type IIIB (case 2) with a residual tibial shaft defect of 8 cm. The residual defect was treated in both cases with an osteoseptocutaneous free vascularized fibular bone graft. The follow-up was performed at 3 weeks, 3 months, 6 months, 1 year and 3 years. The bone graft showed radiological signs of integration at 3 months in both cases. The three-year follow-up revealed good clinical and excellent radiological results in case 1 and excellent clinical and radiological results in case 2. Conclusions: Free vascularized fibula grafting provides an attractive reconstructive option for orthopedic surgery. Free fibular grafting has been proven to be an ideal choice in the management of large segmental bone defects as well as in situations of biological failure of bone healing.

Feasibility of the vascularized fibula bone graft for reconstruction of the mandible: a cadaveric study

The aim of this study was to assess the feasibility of the unilateral single-barrel vascularized fibula bone graft (VFBG) for the restoration of mandibular defects. Eighty-one dry mandibles and fibulas were used. Each mandible was marked to measure the total mandible length (TML) and maximum defect length (MDL) for each type of defect (HCH, H, L, C, HC, LC, LCL, HCL; Boyd's classification and angle to angle). The fibula length (FL) was measured. The maximum vascularized fibula length (MVFL) was calculated as FL – 12 (cm). The feasibility of the unilateral single-barrel VFBG to reconstruct the mandible for each type of defect was determined from the MVFL:MDL ratio. Descriptive statistics, the Student's t-test, and Pearson's correlation coefficient were used for the statistical analysis; significance was set at P<0.05. Average TML, FL, and MVFL were 30.82±1.96cm, 31.75±2.23cm, and 19.75±2.23cm, respectively. The average MVFL:MDL ratios of HCH, LCL, and HCL were all <1. There was a significant positive correlation between TML and FL (r=0.48, P<0.01). The unilateral single-barrel VFBG alone is not feasible for the reconstruction of a near-total or total mandibular defect.

Assessment of the Healing of Vascularized Fibula bone graft in the Reconstruction of the Mandible Using Computed Tomorgraphy

Assessment of the Healing of Vascularized Fibula bone graft in the Reconstruction of the Mandible Using Computed Tomorgraphy

Management of advanced plexiform neurofibromatosis of the foot presenting with skeletal deformation and intractable pain: An indication for proximal amputation

Plexiform neurofibromas of the foot are rare and often present with significant pain, deformity, and functional impairment secondary to their locally invasive behavior. While treatment has traditionally focused on attempts at radical resection, a lack of consensus among surgeons has hindered the establishment of a well-defined algorithm to guide the management of these highly co-morbid peripheral nerve sheath tumors. We present the case of an advanced plexiform neurofibroma of the right foot in a 24-year-old male with neurofibromatosis type 1. The patient presented following accelerated tumor growth with extensive osseous erosion, intractable pain, and progressive ankle instability that limited his capacity to ambulate and wear shoes. A modified transtibial amputation with a vascularized fibular bone graft (Ertl procedure) was performed without complication. Following graduated rehabilitation, postoperatively, the patient regained functional independence and was able to ambulate without pain in a customized prosthesis after 3 months. Plexiform neurofibromas of the foot present a complex challenge for foot and ankle surgeons. On the basis of our experience and previously reported cases, we advocate for amputation over aggressive attempts at advanced limb salvage for patients with extensive skeletal destruction, joint instability, and/or intractable pain caused by tumor mass effect.

Ertl Below-Knee Amputation Using a Vascularized Fibular Strut in a Nontrauma Elderly Population

Tibiofibular bone bridging (Ertl) during a below-knee amputation (BKA) is used to create a stable bony platform, granting the patient improved rotary stability, higher end bearing potential, and ultimately, more functional ambulatory ability. However, limited data are available in the literature on actual patient outcomes, despite numerous reports of the technique. The purpose of this study was to report our experience with distal tibiofibular bone bridging using a vascularized fibular bone graft in an elderly nontrauma population. We performed an institutional review board-approved, retrospective review of BKAs performed by the senior author between 2004 and 2011. Surgical indications, complications, and outcomes were recorded. A subgroup analysis and comparison was performed among patients that had received vascularized bone bridging and those that had not. A total of 294 BKAs were performed on 270 nontrauma patients. Of these, 30 (11%) were done on 29 patients with tibiofibular bone bridging. The mean clinical follow-up among the Ertl subgroup was 11 months (range, 1-42 months), and 17 months (range, 23 days-78 months) in the non-Ertl subgroup. The ambulation rate was 100% (29/29) in the Ertl group, and 78% (161/207) in the control group (P = 0.004). The overall rate of operative revision due to any etiology among groups did not differ significantly (P = 0.255). Tibiofibular bone bridging with vascularized fibula leads to a significantly higher rate of ambulation without a significantly higher rate of complications in a nontrauma population. Although this technique has been widely described in trauma patients, clinical data are lacking for the nontrauma population. This is the largest reported series of Ertl amputations in nontraumatic population to date and our results demonstrate a significant benefit of the Ertl technique in this population. Level IV.

Gastrocnemius-Fibular Flap. A New Pedicled Vascularized Bone Graft Alternative for Femur Pseudarthrosis. Review of 7 Consecutive Clinical Cases

Introduction: In 2009, SAINT-CYR defined the perforasome theory in which flow from linking vessels are maximum in parallel to the axis of limb. According to this principle, we've modified PANDE flap 2002 to a gastrocnemius fibular flap. We've merged skin territories from MCRAW's lateral gastrocnemius musculo-cutaneous flap and YOSHIMURA'S fibular flap, communicating perforators from lateral sural and fibular arteries providing a vascularized fibular bone graft that reaches diaphysis of femur.

Management of Upper Limb Bone Defects Using Free Vascularized Osteoseptocutaneous Fibular Bone Graft

Sixteen patients (11 men and 5 women), who formed the basis of the study, underwent surgery in the Hand and Reconstruction Microsurgical Unit, Orthopedic Department, Sohag Faculty of Medicine, from January 2001 to January 2009.The right side was involved in 7 cases and the left side in 9 cases. Average age was 35.2 years. The causes of bone defects were infected nonunion of both bone forearms in 5 cases, infected nonunion of the middle part of radius in 4 cases, posttraumatic bone loss of distal radius in 4 cases, and tumor of shaft humerus in 3 cases (aneurysmal bone cyst in 1 and osteosarcoma in 2 patients).The principle of treatment was debridement and excision of either infected unhealthy bone or tumor tissues with wide safety margin.The average bone defect was 8 cm (range, 6-14 cm). The defect was bridged by osteoseptocutaneous vascularized fibular bone graft. The donor bone was the right fibula in 7 cases and the left fibula in 10 cases. Two grafts were used in 1 patient because of soft tissue injuries, which included the peroneal vessels during osteotomy. The vascularized fibula was fixed by small dynamic compression plate. The operative time ranged between 7 and 11 hours. Blood transfusion was indicated in all the cases and its average transfusion was 1000 mL. The average follow-up was 84 months. Bone union was ultimately obtained in 15 patients except 1 who had failure of the graft. Arthrodesis of the distal ulna with the wrist joint was done during the follow-up. Arthrodesis of the wrist joint was also performed for 1 patient who had loss of carpal bones, distal radius, and wrist and finger extensors. The average time for union was 3.5 months. The hand function was normal in all cases. Stress fracture and fibular donor-site morbidity did not occur in this series. Neither shoulders nor elbows were affected postoperatively. There was no recurrence for either infection or tumor.

Autologous double-barrel vascularized fibula bone graft for arthrodesis of the shoulder after tumor resection

Arthrodesis of the shoulder is a straightforward and established alternative to reconstruct the shoulder function after tumor resection of the proximal humerus. In most cases, some kind of intercalary bone graft is used to bridge the bony defect. However, due to low stability of a single fibula autograft and disadvantages of exogenous graft material when performing combined allo- and autograft reconstruction, efforts to develop new surgical techniques, with the intention to lower the complication rates, are ongoing. We present a detailed description of the surgical technique and the outcome of three patients with osteosarcomas of the proximal humerus, which were treated with tumor resection and autologous double-barrel vascularized fibula bone graft for arthrodesis of the shoulder. The construct was stabilized using a 4.5-mm pelvic reconstruction plate positioned on the scapular spine and the lateral aspect of the humerus. A wide surgical margin was achieved in all patients. Two of them could be reintegrated and are able to work with excellent shoulder function. In one patient, who developed metastasis, a deep infection under chemotherapy 16months after index surgery complicated the postoperative course. The fibula's unique dual endosteal and periosteal blood supply makes it effective as a double-barrel bone graft for major long bone defects, which requires extra bone volume to prevent fractures until bone hypertrophy occurs. Additional bone and scar formation between the two struts are believed to provide a stable and long lasting construct, as seen in our patients.

Alveolar Distraction Osteogenesis for Dental Implant Rehabilitation Following Fibular Reconstruction: A Case Series

Alveolar distraction osteogenesis (ADO), a novel bone augmentation technique, is gaining acceptance in restoring the vertical bone discrepancy between the transplanted graft and the residual alveolar bone after mandibular reconstruction. This case series presents the outcomes of ADO in fibula-reconstructed mandibles rehabilitated with dental implants, with an emphasis on clinical indications, surgical protocol, clinical outcomes, histologic evidence, and complications. Five patients underwent fibula distraction procedures after undergoing mandibular reconstruction with a vascularized fibula bone graft. The indication for the application of ADO was for the correction of the vertical discrepancy between the top of the reconstructed fibula and the adjacent alveolar crest to achieve adequate vertical bone height before implant placement. The mean vertical bone height achieved was 13.58 mm. Twenty-two dental implants were placed in 5 patients. All patients were rehabilitated with implant-supported prostheses. Bone biopsies showed the distracted area was filled with newly formed, bony trabeculae between the transported fibula and the basal segments. The most common complication was transient infection around the distractor rod. ADO can be performed on fibula-reconstructed mandibles to achieve the restoration of alveolar height, which then can be rehabilitated with dental implant-supported prostheses. The procedure has a minor risk of infection associated with the distractor rod, which does not compromise the bone regeneration from distraction. Patients with mandibles reconstructed with fibulas can attain dental implant rehabilitation with ADO, achieving good esthetic and occlusal outcomes.

Management of postinfection defects in long bones with a vascularized fibular bone graft

Background Management of chronic osteomyelitis is a difficult task, complicated by problems including combined bone and soft-tissue loss, bacterial colonization, fibrotic local tissue, and local factors detrimental to wound healing. Vascularized bone grafts, by definition, are placed with their vascularity intact and are thus immediately viable. Objective The aim of this study was to review the clinical and radiographic results of a vascularized fibular graft (VFG) in the management of defects in upper and lower limbs with chronic osteomyelitis. Patients and methods Six patients with chronic osteomyelitis (two tibiae, two ulnae, one femur, and one radius) underwent radical debridement, followed by reconstruction using a VFG, and were evaluated for radiographic and clinical success using standard anteroposterior and lateral radiographs. Four men and two women were included and their average age at surgery was 38.8 years (range 30-50 years). Union, solid hypertrophy, range of motion, grip strength, failure of anastomosis, and recurrence of infection were evaluated at the final follow-up. Results Radiological assessment indicated union in all cases after an average period of 10.6 weeks in upper limb cases and 18 weeks in lower limb cases. Solid hypertrophy and weight bearing were allowed for lower limb cases after an average period of 12 months. No failure of the graft or recurrence of infection was encountered in this study. Conclusion VFG for the reconstruction of long bone defects following radical debridement in cases of chronic osteomyelitis effectively achieves union and eradicates infection.