Ipsilateral Pedicle Vascularized Fibula Grafts for Reconstruction of Tibial Defects and Non-Unions

Toh, Satoshi; Tsubo, Kenji; Nishikawa, S.; Narita, Shunsuke; Kanno, Hiromasa; Harata, Seiko

doi:10.1055/s-2001-17751

Cited by 25 publications

(14 citation statements)

References 23 publications

(26 reference statements)

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“…13 Fracture of the fibula graft was present in an average of 8.5% of cases, sound union was achieved usually within 6 months, and patient mobilization and final outcome are reported as good in most cases. 14,15,27,28 The results we obtained in this case are consistent with the literature, and we believe that this case report highlights the usefulness of a ''forgotten'' procedure. We have no doubt that free vascularized fibula grafts, segmental allografts, and limblengthening techniques are useful, but we believe that a younger generation of orthopaedic surgeons is not familiar with this relatively straightforward method of treating large tibial defects.…”

Section: Discussionsupporting

confidence: 95%

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A Simple Treatment for a 15-cm Tibia Bone Defect: A Case Report of an Ipsilateral Vascularized Fibula Transfer

Koulouvaris¹,

Theos²,

Kottakis³

et al. 2007

Journal of Orthopaedic Trauma

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Segmental defects of the tibia present a challenging problem. This report demonstrates the use of an ipsilateral vascularized fibula transfer (IVFT) in a patient with a 15 cm tibial bone defect following tumor resection. Bone union was achieved within 6 months, and 8 years after the surgery the patient has full knee flexion and extension and is still employed in the same vocation as he was prior to surgery. With current interest in reconstructive techniques such as vascularized fibular grafts, segmental allografts, and bone transportation, the technique of ipsilateral vascularized fibula transfer has become neglected. The purpose of this case report is to highlight its use and draw attention to its advantages and disadvantages.

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Section: Discussionsupporting

confidence: 95%

“…The operative technique that was used has been described by several authors. 15,27,29 An anterolateral approach was used both for tumor resection and for transferring of the fibula leaving the periosteum intact. Meticulous dissection of the vascular pedicle was performed as well as decortication of the medial aspect of the fibula.…”

Section: Case Reportmentioning

confidence: 99%

A Simple Treatment for a 15-cm Tibia Bone Defect: A Case Report of an Ipsilateral Vascularized Fibula Transfer

Koulouvaris¹,

Theos²,

Kottakis³

et al. 2007

Journal of Orthopaedic Trauma

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“…The stress fractures observed occurred in reconstructions with fibula free flap and were mainly related with the fibular thinness and premature deambulation. A solution to minimize this risk is the folding of fibula flap as advocated by Toh et al [7].…”

Section: Discussionmentioning

confidence: 99%

Lower limb reconstruction with bone free flaps: experience of 25 cases

et al. 2011

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Bone structure is fundamental for the function of the lower limbs-orthostatism and locomotion. Before the technical evolution observed in the last two decades, many extremities that are saved now were amputated in the past. Lower limb bone defects are generally associated with complex traumatic lesions and constitute a permanent reconstructive challenge. The management of this kind of defect requires a multidisciplinary approach involving plastic and orthopedic surgeons. The bone free flaps are a very important and technically exacting tool for lower limb bone reconstruction. We present and analyze our experience in 25 traumatic cases where we used 17 fibula free flaps and 2 iliac crest free flaps for tibia and talus reconstruction; 5 fibula free flaps for femur reconstruction; and 1 antebrachial radial osteocutaneous free flap for first metatarsal reconstruction. We registered 88% of success (three flap necroses-12%) with good bone integration and good functional recovery. Lower limb bone reconstruction is a long and tortuous stair whose success depends not only on the multidisciplinary surgical team but also on the patient's cooperation and determination

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“…Application of papaverine and dextran-40 can effectively promote the patency rate of anastomosed blood vessels. Stress fracture of a vascularized fibular graft is a complication that had been reported by many authors, even in early hypertrophied bone (Toh et al, 2001;Ceruso et al; Repetitive mechanical loading which exceeds the bone strength was the main cause of this complication. The application of external fixation was required in case of fractures of the grafting fibula after the operation, the commonly used external fixation device were external fixator or splint.…”

Section: Discussionmentioning

confidence: 99%

Vascularized fibular graft combined with vacuum assisted closure in the reconstruction of tibial defects

Liu¹,

Song²,

Xu³

et al. 2015

Afr. J. Trad. Compl. Alt. Med.

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Background: To investigate the application of Flow-through free vascularized fibular graft combined with Vacuum Assisted Closure for the patients suffering from tibial defects caused by chronic osteomyelitis. Methods: We retrospectively analysed 20 cases of patients who accepted this operation in the treatment of tibial defects. Among the tibial defects, six cases resulted from blood stream infection while 14 cases resulted from comminuted fractures. All the patients included in the study were accompanied with 1 to 3 sinuses. The length of the defects ranged from 6cm to 16cm, with an average of 11.3cm. 6 patients were also faced with soft tissues defects combined with tendon or bone exposures, and the defects areas ranged from 11cm×7cm to 19cm×14cm. There were 5 patients suffering from fibular fractures at the same side of the defects. The courses of this disease were 5.5 -15 months, with an average of 9.8 months.Results: The patients included in the study were followed up from 10 months to 4 years, with an average of 1.9 years. Sinuses of 18 patients healed within 4 weeks, giving a primary healing rate of 90%. We undertook debridement of the remaining sinuses and they healed within 2 weeks. All skin flaps grafted to the patients survived, thus the survival rate was 100%. The radiographs indicated that 18 patients had good prognosis and the primary union time of grafting fibula were from 4 to 8 months, with average of 6.3 months. The healing patients achieved an average of 25.6 points based on the Enneking evaluation system which was used to evaluate the function of limbs after the operation, indicating that 85.9% of the limb function recovered. 4 patients required revision surgery for complications resulting from the operation: 1 wound breakdown, 2 bone non-unions, 1 graft fracture. Infection occurred only as a pin-tract infection, and was controlled with oral antibiotics and repeated dressing; there was no deep infection out of control in any of these patients. Conclusion:The flow-through free vascularized fibular graft did not only repair tibial defects, but retained the continuity of trunk vessels. The flowthrough fibular graft combined with Vacuum Assisted Closure (VAC) controlled the infection, shortened the course of treatment, and effectively restored limb function when applied to the treatment of tibial defects.

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Ipsilateral Pedicle Vascularized Fibula Grafts for Reconstruction of Tibial Defects and Non-Unions

Cited by 25 publications

References 23 publications

A Simple Treatment for a 15-cm Tibia Bone Defect: A Case Report of an Ipsilateral Vascularized Fibula Transfer

A Simple Treatment for a 15-cm Tibia Bone Defect: A Case Report of an Ipsilateral Vascularized Fibula Transfer

Lower limb reconstruction with bone free flaps: experience of 25 cases

Vascularized fibular graft combined with vacuum assisted closure in the reconstruction of tibial defects

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