BackgroundFree vascularized fibula flap represents the gold standard vascularized bone graft for the management of segmental long bone defects after traumatic injury. The current study represents the largest retrospective multicenter data collection on the use of free fibula flap (FFF) for extremities' orthoplastic reconstruction after trauma aiming to highlight current surgical practice and to set the basis for updating current surgical indications.MethodsThe study is designed as a retrospective analysis of prospectively collected data between 2009 and 2021 from six European University hospitals. Patients who underwent fibula flap reconstruction after acute traumatic injury (AF) or as a late reconstruction (LF) after post‐traumatic non‐union of upper or lower limb were included. Only extra‐articular, diaphyseal fracture were included in the study. Surgical data were collected. Time to bone healing and complications were reported as clinical outcomes.ResultsSixty‐two patients were included in the study (27 in the AF group and 35 in the LF group). The average patients' age at the time of the traumatic event was 45.3 ± 2.9 years in the AF group and 41.1 ± 2.1 years in the LF group. Mean bone defect size was 7.7 ± 0.6 cm for upper limb and 11.2 ± 1.1 cm (p = .32) for lower limb. Bone healing was uneventful in 69% of treated patients, reaching 92% after complementary procedures. Bone healing time was 7.6 ± 1.2 months in the acute group and 9.6 ± 1.5 months in the late group. An overall complication rate of 30.6% was observed, with a higher percentage of late bone complications in the LF group (34%), mostly non‐union cases.ConclusionsFFF reconstruction represents a reliable and definitive solution for long bone defects with bone healing reached in 92% cases with a 8.4 months of average bone healing time.
ObjectivesTo assess long-term sexual outcome and quality of life after perineal reconstruction by pedicled anterolateral thigh (ALT) flaps after Fournier's gangrene. Postoperative surgical outcomes were assessed; quality of life and sexual function were assessed at long term follow-up (>12 months) with 2 scientifically validated questionnaires.MethodsWe conducted a retrospective analysis of a prospectively maintained database. Long-term sexual function and quality of life were assessed by standardized questionnaires. Descriptive statistics were conducted.Results8 patients were included in our study, 5 patients responded to quality of life and sexual function analysis. Surgical outcomes were in line with literature: one minor complication (minor dehiscence requiring a skin graft), one major complication (flap loss, requiring a second, contralateral flap) occurred. No reconstructive failure occurred. Average time to complete wound healing was 17 days (SD ±5). Quality of life scores over 70/100 in four out of five categories; social function was rated lowest: patients reported very few residual complaints. Sexual outcome analysis emphasizes the positive impact of the reconstruction. As expected, Fournier's Gangrene heavily affected patient's sexual health.ConclusionsPerineal reconstruction with ALT shows excellent quality of life, and good sexual health outcomes. Currently the lack of reliable and relatable data leads to the impossibility to compare different reconstructive procedures. We emphasize that assessing sexual function and quality of life after perineal reconstruction is paramount to weigh reconstructive success.
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