Reconstruction of a complicated adjacent non-union of the radius and ulna using a free vascularised double-barrel fibula graft

Abstract

While the free vascularised double-barrel fibula flap has been traditionally used in the reconstruction of defects in the long bones of the lower extremities, the advantages of this type of graft can also be seen in the treatment of adjacent radial and ulnar non-unions of the forearm. The main advantage of the double-barrel fibula flap in treatment of antebrachial non-unions is that it allows for the simultaneous anatomical reconstruction of the radius and the ulna while maximising forearm functionality. In contrast to other procedures, this tailored graft also helps preserve pronation and supination of the forearm. In this article, we chronicle a case in which a microvascular osteomyocutaneous double-barrel fibula flap was used to concurrently reconstruct the radius and ulna of a patient with a severe antebrachial non-union.

Free Double-Barrel Vascularized Fibular Graft for Two-Bone Forearm Reconstruction After Tumor Resection

“…13 Although the use of dbFVFGs has been advocated for pelvic ring, spinal, femoral, and tibial reconstruction with good results 6 , its application in forearm reconstruction is limited to only a small number of cases of posttraumatic bone defects, infection nonunion, or congenital pseudoarthrosis because of its rare indication. The time required for consolidation ranged between 3 and 10 months, except for 1 case of nonunion at 1 conjunction site [7][8][9][10][11][12][13] . Recent literature has highlighted two-bone reconstruction method by which antebrachial pronosupination 9,10 and long-term function might be maximally restored 13 .…”

Reconstruction of an infected midshaft radius and ulna nonunion using a free vascularized fibula and medial femoral condyle flap

“…Alternatively, the so‐called “double barrel” or “folded” FVF variant can be utilized. This modification allows the reconstruction of both forearm bones in adjacent antebrachial pseudarthrosis, by sectioning the fibular graft in two fragments linked by a pedicled bridge (Frary et al, 2016; Jones Jr et al, 2012; O'Brien et al, 1988). Other possibilities include vascularized rib, scapula, or ilium grafts, although these flaps are not ideal for the reconstruction of long straight bone defects and are generally less predictable (De Smet, 2009; Wood & Bishop, 2007; Yajima et al, 1999).…”

Application of Microsurgical Technique in Treatment of Congenital Pseudarthrosis of the Forearm in Children With Neurofibromatosis

“…В 14% случаев сращение достигнуто у пациентов младше 5 лет. По мнению авторов, у более молодых пациентов чаще происходит резорбция костных аутотрансплантатов ввиду плохой фиксации и тонких остеопоротических фрагментов [24,25].…”