Reconstruction of extremity long bone defects with vascularized fibula bone grafts

Abstract

Aim: Composite tissue defects encompassing bone and/or isolated bony defects can pose a surgical challenge; however, their reconstruction is critical for successful functional limb salvage. These cases become increasingly problematic as secondary defects, following multiple nonvascularized grafting attempts resulting in complex bony nonunion. Herein, our experience utilizing fibula vascularized bone grafts (VBGs) for bone restoration will be presented to demonstrate their utility in a variety of reconstructions for limb salvage. Methods: This is a case series describing a series of vascularized fibula grafts for extremity reconstruction performed by a single academic surgeon over multiple institutions in seven years. Results: Twenty-seven (27) total VBGs met inclusion criteria and underwent reconstruction for traumatic (16), oncologic (6) and chronic degenerative (5) etiologies. Bony union was achieved in 26 of 27 cases. Conclusion: The decision-making process for bony reconstruction in these scenarios is difficult and multivariable. Fibula VBGs can provide a single-stage solution for autologous bony and soft tissue replacement of large or complex bone defects and can often be superior options compared with non-vascularized bone grafts or non-bone internal fixation techniques. Their osteogenic potential is unmatched by allogenic or synthetic substitutions. These benefits are evident in a variety of clinical settings such as pediatrics, oncology and trauma.

Outcomes of Surgical Reconstruction Using Custom 3D-Printed Porous Titanium Implants for Critical-Sized Bone Defects of the Foot and Ankle

“…27 CSDs can be secondary to multiple etiologies including trauma, osteonecrosis, infection, tumor, after acute deformity correction, and after removal of failed total ankle replacement. 8,25,37…”

Efficacy of free fibula flap for reconstruction of post traumatic long bone defect: retrospective study of eighteen cases

“…Aetiologies of segmental defect are congenital bone defect, post traumatic, post oncologic resection, osteomyelitis, tuberculosis of bone, avascular necrosis etc. [4][5][6][7] Different options for bone reconstruction use either autogenous tissue, allo bonegraft or alloplastic materials. 5 Among autogenous tissues non vascularised or vascularised bone grafts, distraction osteogenesis are the most popular mode to bridge a segmental defect.…”

“…[4][5][6][7] Different options for bone reconstruction use either autogenous tissue, allo bonegraft or alloplastic materials. 5 Among autogenous tissues non vascularised or vascularised bone grafts, distraction osteogenesis are the most popular mode to bridge a segmental defect. While non-vascularised bones are used for small defect (<6 cm), vascularised bone graft or distraction osteogenesis are popularly used to bridge longer bone gap.…”

“…Free fibula provides vascularised bone graft and incorporates all osteoinductive, osteoconductive osteoprogenitor element to recipient bone healing. 5 Septocutaneous perforators provides good amount of reliable soft tissue to fill the soft tissue in composite bone defect. Use of free vascularised fibula was mentioned for a variety of bone defect including Gustilo type III lower limb injury, long segmental defect, non-union, avascular necrosis, joint arthrodesis.…”

Enhancing the Efficiency of Distraction Osteogenesis through Rate-Varying Distraction: A Computational Study

“…Repair of large bone defects remains a challenge in orthopaedics. Although numerous techniques are available as treatment options, including autogenous bone grafts, allografts, bone graft substitutes, and vascularized fibular bone grafts [1][2][3], distraction osteogenesis (DO)-an in vivo tissue engineering approach-remains the clinical gold standard for treating large bone defects [4,5].…”