Case Reports: Lengthening of a Vascularized Free Fibular Graft

Abstract

Wide bone resection is sometimes necessary for bone tumors, and reconstruction is a major challenge. Vascularized fibular graft is one alternative but may result in progressive limb-length discrepancy (LLD) in children with substantial growth left. Progressive distraction lengthening with an external fixator is now a standard procedure to generally correct LLD. However, lengthening of free vascularized fibular grafts for lower limb reconstruction has not been reported frequently and then only in small series or case reports. We report our experience with three patients with lengthening after tibial reconstruction with a free vascularized fibular graft and review the literature.

Lengthening of free fibular grafts for reconstruction of the residual leg length discrepancy

“…De Boer and Wood [34] suggested that 80% hypertrophy of the FVFG should be observed at the 2-year’ follow-up. Courvoisier A et al reported that three years after the FVFG seems to be a safe delay [32]. In their study, the mean age of their patients at surgery was 12 years, and the mean interval between the end of reconstruction and lengthening was 10 years.…”

“…There are no guidelines for the lengthening procedure of a FVFG and various types of fixators have been used for bone lengthening. Some authors suggest that fibular graft lengthening using an external fixator is a safe and effective method for correcting LLD [32].…”

“…Some authors suggest that fibular graft lengthening using an external fixator is a safe and effective method for correcting LLD [32].…”

“…In order to achieve the desired distraction without joint instability, the knee and foot were not included in the frame and daily physiotherapy was required. No matter where you make the osteotomy, the literature [32] showed that bone ingrowth were always succeed (Table 2). The site of osteotomy was performed in the FVFG in our two cases, and bone ingrowth were achieved at last.…”