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González-Herranz, P.; Río, Angel del; Burgos, Jesús; López-Mondejar, J A; Rapariz, J. M.

doi:10.1097/00004694-200301000-00011

Cited by 24 publications

(10 citation statements)

References 16 publications

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“…There have been reports of regeneration of the resected fibular shaft [11, 26, 29, 30]; to our knowledge, there have been no reports of regeneration of the proximal third of fibula. Bettin et al [26] studied regeneration of the donor site in 53 patients undergoing transplantation of the fibular shaft and found an age < 15 years to be the only predictor of regeneration.…”

Section: Discussionmentioning

confidence: 99%

“…Herranz et al have associated absence or incomplete regeneration of the fibula with the development of valgus deformity of the tibia in children and adolescents. They recommend preserving the periosteum to encourage complete fibular regeneration [11]. The scarcity of regeneration of the ends of the fibula can be understood through a detailed knowledge of the blood supply of the fibula and its periosteum.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple authors have reported proximal migration of the fibula, ankle valgus deformity and tibial diaphyseal valgus deformity after resecting the fibular shaft [11, 31–34]. Little is known if such changes also occur following resection of the fibular head.…”

Section: Discussionmentioning

confidence: 99%

“…Proximal migration was measured as the distance between the tip of the lateral malleolus and the distal tibial articular surface in comparison with the opposite side [11]. The tibiotalar angle was measured to assess ankle valgus [11, 12]. A change of 5° or more was regarded as a valgus deformity [12].…”

Section: Methodsmentioning

confidence: 99%

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Outcomes and complications of fibular head resection

Agarwal¹,

Saseendar²,

Patro³

et al. 2012

Strategies in Trauma and Limb Reconstruction

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The fibular head is often used as donor graft material for reconstruction of defects of the distal radius. However little is known on the safety of such a procedure. This report describes the long-term donor-site morbidity following the procedure. Fourteen patients who underwent simple or marginal resections of the proximal fibula between 1990 and 2007 were reviewed. Subjective donor-site morbidity, knee and ankle range of motion and instability, presence of sensory or motor function loss, gait and fibular regeneration were assessed. The mean age at surgery was 25 years; six were male, eight were female and the mean follow-up was 11 years. Abnormal clinical findings were present in 10 patients (71.4 %): nine patients (64.3 %) had Grade 2 varus laxity at the knee confirmed by stress radiographs; one had sensory loss in the distribution of the superficial peroneal nerve. Patients with varus laxity had significantly higher mean age at surgery than those without varus laxity (p = 0.001). None had deformity at the knee or ankle. The range of joint movements was normal. All had a normal tibiotalar angle and none had proximal migration of the fibula. One patient demonstrated near-complete regeneration of the fibula. Donor-site morbidity following simple and marginal resection of the proximal fibula is acceptable. Older patients had a higher risk of demonstrable varus laxity at the knee but proximal fibula resection in children appears to be safe.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Outcomes and complications of fibular head resection

Agarwal¹,

Saseendar²,

Patro³

et al. 2012

Strategies in Trauma and Limb Reconstruction

View full text Add to dashboard Cite

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“…Shortening of the fibula in children due to acquired segmental loss by trauma, osteomyelitis or congenital pseudoarthrosis results in upward migration of the distal fibula and valgus deformity with some instability 9). Hsu and coworkers3,4) reported that these phenomena are due to retarded longitudinal growth of the fibula through the loss of the physiological lateral thrust of the proximal fibula to the distal fibular physis, which leads to an upward migration of the fibula, lateral tibial epiphyseal wedging and valgus orientation of the ankle joint line 1,10).…”

Section: Discussionmentioning

confidence: 99%

Ankle Deformity Secondary to Acquired Fibular Segmental Defect in Children

et al. 2010

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BackgroundThe authors report the long-term effect of acquired pseudoarthrosis of the fibula on ankle development in children during skeletal growth, and the results of a long-term follow-up of Langenskiold's supramalleolar synostosis to correct an ankle deformity induced by an acquired fibular segmental defect in children.MethodsSince 1980, 19 children with acquired pseudoarthrosis of the fibula were treated and followed up for an average of 11 years. Pseudoarthrosis was the result of a fibulectomy for tumor surgery, osteomyelitis of the fibula and traumatic segmental loss of the fibula in 10, 6, and 3 cases, respectively. Initially, a Langenskiold's operation (in 4 cases) and fusion of the lateral malleolus to the distal tibial epiphysis (in 1 case) were performed, whereas only skeletal growth was monitored in the other 14 cases. After a mean follow-up of 11 years, the valgus deformity and external tibial torsion of the ankle joint associated with proximal migration of the lateral malleolus needed to be treated with a supramallolar osteotomy in 12 cases (63%). These ankle deformities were evaluated using the serial radiographs and limb length scintigraphs.ResultsIn all cases, early closure of the lateral part of the distal tibial physis, upward migration of the lateral malleolus, unstable valgus deformity and external tibial torsion of the ankle joint developed during a mean follow-up of 11 years (range, 5 to 21 years). The mean valgus deformity and external tibial torsion of the ankle at the final follow-up were 15.2° (range, 5° to 35°) and 10° (range, 5° to 12°), respectively. In 12 cases (12/19, 63%), a supramalleolar corrective osteotomy was performed but three children had a recurrence requiring an additional supramalleolar corrective osteotomy 2-4 times.ConclusionsA valgus deformity and external tibial torsion are inevitable after acquired pseudoarthrosis of the fibula in children. Both Langenskiöld supramalleolar synostosis to prevent these ankle deformities and supramalleolar corrective osteotomy to correct them in children are effective initially. However, both procedures cannot maintain the permanent ankle stability during skeletal maturity. Therefore any type of prophylactic surgery should be carried out before epiphyseal closure of the distal tibia occurs, but the possibility of a recurrence of the ankle deformities and the need for final corrective surgery after skeletal maturity should be considered.

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Complete rehabilitation of the mandible following segmental resection

Schrag

Chang

Tsai

et al. 2006

Journal of Surgical Oncology

110

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Segmental resection of the mandible leads to significant patient morbidity. Loss of mandibular support to the teeth, tongue and lip causes dysfunctional mastication, swallowing, speech, airway protection and oral competence. Patients also suffer disfigurement following segmental mandibulectomy because the mandible is an important aesthetic landmark. The degrees to which dysfunction and disfigurement occur depend both on the location of the mandibular segment removed and the amount of surrounding soft tissue excised. Between January 1985 and December 2004, 780 fibula osteoseptocutaneous flaps have been used for head and neck reconstruction at the Chang Gung Memorial Hospital, Taiwan. The fibula flap has proven to be the bony flap of choice because it has a lengthy bicortical segment of bone available, a reasonably long vascular pedicle, large diameter vessels, good bone quality, and is easily contoured with multiple osteotomies. The flap can be harvested while ablation is being performed. In addition, a reliable, mobile, thin skin component can always be included to address the soft tissue reconstructive requirements. A chimeric design employing a portion of the soleus muscle can provide further reconstructive options. Ideally complete rehabilitation of the mandible involves placement of titanium osseointegrated implants, which allow dental restoration. Primary placement of implants is preferred in patients without cancer. Selection of candidates to receive osseointegrated implants is paramount. The temporomandibular joint remains a challenge to reconstruct adequately.

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Cited by 24 publications

References 16 publications

Outcomes and complications of fibular head resection

Outcomes and complications of fibular head resection

Ankle Deformity Secondary to Acquired Fibular Segmental Defect in Children

Complete rehabilitation of the mandible following segmental resection

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