Vascularized Fibula Transfer Research Articles

Periostale und intraossäre Versorgungsstrukturen der Fibula und ihre klinische Bedeutung

The angioarchitecture of the human fibula was investigated by anatomical dissection. The main artery of the periosteal and endosteal blood supply is the arteria fibularis. The proximal part of the facies lateralis is additionally nourished by a well-built branch of the arteria tibialis anterior. The periosteal branches of the arteria fibularis are most voluminous on the dorsal side in the middle of the fibula. Small plates take care of these branches. For an additional revascularization the well-built branch of the arteria tibialis anterior is proposed. The best anatomical region for a vascularized fibular transfer is at an average of 20% up to 75% of the fibular length.

Effectiveness of the pedicled vascularized fibula graft to reconstruct tibial defects

Free vascularized fibula grafts have been used to reconstruct long tibial bone defects since Taylor's report in 1975. A pedicled vascularized fibula graft is also useful for small bone defects or pseudoarthrosis because of its excellent vascularity. The pedicled vascularized fibula transfer does not need the microvascular anastomosis and can be performed in much less time. It can be distally or proximally pedicled, depending on the site of the bone defect. A proximally or distally pedicled vascularized fibula with or without a monitoring flap was transferred in five cases of small bone defects and pseudoarthrosis of the tibia. In all 5 cases, the postoperative course was uneventful and good bony union was obtained.

Reconstruction of the humerus by soft tissue distraction and vascularized fibula transfer

We report a case of reconstruction of the humeral shaft by soft tissue lengthening according to the method of Ilizarov, followed by skeletal reconstruction with a vascularized fibular graft. Skeletal union and initiation of functional activity were achieved within 4 months. Lengthening of the soft tissue and the vascular tree by slow distraction did not compromise the subsequent reconstructive microsurgical procedure.

The longitudinally split vascularized fibula with a vascularized periosteal flap for the reconstruction of large segmental bone defects of the tibia

A new principle in reconstructive surgery is presented: “The immediate reconstruction of a missing bone segment with a primary osteoperiosteal tube that will secondarily be transformed into a complete osseous tube. ” In 5 out of 7 baboons, a bone tube with an almost normal bone cavity was achieved after 16 to 28 weeks. In 2 cases, we failed to reconstruct the tube because of an intraoperative fault and postoperative plate fracture with subsequent destruction of the vascularized periosteal flap. On the basis of this study, we describe a new concept in reconstruction of segmental bone defects of the lower extremity. The osteoperiosteal tube is formed by the combination of two successful experimental and clinical techniques: the vascularized fibular transfer which is modified by splitting the bone graft longitudinally, and transfer of vascularized periosteum (“concept of the substitution of a missing bone segment by an organ-like tube”). In the most stressed marginal region of the bone defect, there is vascularized cortical bone from the longitudinally split fibular graft and an increasing amount of lamellar bone being produced under the vascularized periosteal flap. By splitting the graft, nutrition depends entirely on the periosteal blood supply. The “concept of the dual blood supply” was initially described by Berggren et al. and Papanastasiou et al. [4, 18]. The significance of the “concept of the vascularized periosteum transfer for reconstruction of a segmental bone defect” is well illustrated. Only in cases where the vascularized periosteal flap was intact and securely sutured to the fibulae graft and the two tibia stumps could a bone tube be reconstructed. The arrangement of both vascularized grafts as an osteoperiosteal tube exemplify the “concept of the given space” as described by Stock et al. [26]. Inside the osteoperiosteal tube, a “consolidation chamber” is created in which all the factors required for bone formation can be concentrated. Comparison of the results of successfully reconstructed bone tubes with the solid bone column in the defect of the baboon where no bone tube could be reconstructed underline the “concept of combination of different vascularized grafts for reconstruction of segmental bone defects in long bone defects of the lower extremity.”

Free vascularized fibula transfer in the management of congenital pseudarthrosis of the tibia

MicrosurgeryVolume 12, Issue 3 p. 170-174 Frontiers in Microsurgery: Pediatric Extremity Microsurgery Free vascularized fibula transfer in the management of congenital pseudarthrosis of the tibia Radovan Manoylovic M.D., Radovan Manoylovic M.D. Department of Orthopaedic Surgery, University of California, San Francisco; San Francisco, CASearch for more papers by this authorJoseph C. Cheng M.D., Joseph C. Cheng M.D. Department of Orthopaedic Surgery, University of California, San Francisco; San Francisco, CASearch for more papers by this authorDavid G. Levinsohn M.D., David G. Levinsohn M.D. Department of Orthopaedic Surgery, University of California, San Francisco; San Francisco, CASearch for more papers by this authorLeonard Gordon M.D., Corresponding Author Leonard Gordon M.D. Department of Orthopaedic Surgery, University of California, San Francisco; San Francisco, CADepartment of Orthopaedic Surgery, University of California, San Francisco; San Francisco, CA 94143-0332Search for more papers by this author Radovan Manoylovic M.D., Radovan Manoylovic M.D. Department of Orthopaedic Surgery, University of California, San Francisco; San Francisco, CASearch for more papers by this authorJoseph C. Cheng M.D., Joseph C. Cheng M.D. Department of Orthopaedic Surgery, University of California, San Francisco; San Francisco, CASearch for more papers by this authorDavid G. Levinsohn M.D., David G. Levinsohn M.D. Department of Orthopaedic Surgery, University of California, San Francisco; San Francisco, CASearch for more papers by this authorLeonard Gordon M.D., Corresponding Author Leonard Gordon M.D. Department of Orthopaedic Surgery, University of California, San Francisco; San Francisco, CADepartment of Orthopaedic Surgery, University of California, San Francisco; San Francisco, CA 94143-0332Search for more papers by this author First published: 1991 https://doi.org/10.1002/micr.1920120306Citations: 5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume12, Issue31991Pages 170-174 RelatedInformation

Reconstruction of large skeletal defects by vascularized fibula transfer

We have studied the results of reconstruction of a large skeletal defect using a vascularized fibula graft in 62 consecutive cases. We were particularly interested in factors that may significantly influence the outcome of union. In at least 90% of cases, eventual union can be expected in the reconstruction of large skeletal defects resulting from tumour resection, traumatic bone loss, or nonunion. The results of reconstruction for osteomyelitis were less favorable. Statistical analysis of the influences of bone graft polarity, internal fixation, additional bone graft polarity, internal fixation, additional bone graft material, and the length of the graft on the outcome of union revealed that the use of stable fixation and additional bone graft material significantly enhanced bone union, whereas the length or polarity of the graft had no influence.

A quantitative analysis of donor site morbidity after vascularized fibula transfer.

Eleven patients with free vascularized fibula graft transplants to the upper extremity were studied for donor-side morbidity effects. Based on their surgical follow-up times, the patients were divided into either group 1 (5 +/- 2 months) or group 2 (21 +/- 8 months) to examine the effects of surgical trauma more closely. Gait evaluation was performed using two walkways containing different ground conditions. Knee and ankle-foot motion was measured using a three-dimensional electrogoniometer. Basic temporodistance factors and ground reactions were obtained from foot switches, instrumented floor mats, and a force plate. A modified Cybex II isokinetic dynamometer was used to quantitate ankle-foot strengths. Moderate knee and ankle-foot motion changes were seen while walking on the level, sideslope, and ramp in patients evaluated less than 10 months after their surgical procedure. Minimal joint motion effects were discovered in patients with follow-up times longer than 10 months. Muscle strengths were significantly impaired in both groups, especially foot inversion and eversion. An inverse relationship existed between the length of resected fibula and ankle evertor muscle strength. Donor side morbidity does not appear to be caused by surgical soft-tissue trauma exclusively. These patients need to be studied for several more years to determine the long-term functional effects of free vascularized fibular graft transfer.

Upper extremity reconstruction by vascularized bone transfers: Results and complications

Twenty-one cases of vascularized fibula transfer for upper limb reconstruction are reviewed. Recipient sites included the humerus in 11 patients, radius in five, ulna in three, and clavicle in two. Overall, primary bone union occurred in 15 patients (71.4%), and eventual union was achieved in 17 patients (81%). Two of the patients in whom there was failure to unite are minimally symptomatic, with stable fibrous nonunions. The most favorable results were achieved in cases of forearm bone reconstruction (100% union) and for long-bone reconstruction after tumor resection (83% union).