The use of vascularized fibular grafts for the reconstruction of spinal and sacral defects

Moran, Steven L.; Bakri, Karim; Mardini, Samir; Shin, Alexander Y.; Bishop, Allen T.

doi:10.1002/micr.20655

Cited by 56 publications

(45 citation statements)

References 52 publications

(53 reference statements)

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“…Bone grafts depend upon the defect's size, location and instability. Whilst non-vascularised (rib/fibular/iliac crest) grafts can be used they are not ideal if soft tissue has been compromised by previous surgery, persistent infection, wide resections or radiotherapy [9,10]. In cases involving multiple level resection like ours, vascularised bone grafts prove ideal [8,10].…”

Section: Reconstructionmentioning

confidence: 99%

“…Whilst non-vascularised (rib/fibular/iliac crest) grafts can be used they are not ideal if soft tissue has been compromised by previous surgery, persistent infection, wide resections or radiotherapy [9,10]. In cases involving multiple level resection like ours, vascularised bone grafts prove ideal [8,10]. Theoretically, vascularised grafts should not be utilised with tumours as graft blood flow into the tumour bed could facilitate tumour cell dissemination and recurrent tumour growth, however, the risk of this occurring is low following en bloc resections [8,11].…”

Section: Reconstructionmentioning

confidence: 99%

“…However, recent studies have shown that patients with lumbosacral defects following spinal tumour resection and radiation, where traditional bone graft use is not possible, can have free vascularised fibular grafts to achieve successful bony union in an average of 4.5 months [9,10]. Disadvantages of free vascularised fibular grafts include increased operating times, increased blood loss and technical difficulties achieving microvascular anastomoses.…”

Section: Reconstructionmentioning

confidence: 99%

“…Whilst operation times are significantly longer, the amount of blood loss in fibular harvest generally does not require transfusion [9,11]. Complications caused by fibular harvesting include transient peroneal nerve palsy, non-union, flap failure, infection and hematoma [10], however, these are uncommon [9].…”

Section: Reconstructionmentioning

confidence: 99%

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Extensive lumbar chordoma and unique reconstructive approach

Sivabalan

Mobbs

2011

Eur Spine J

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Chordomas are rare, malignant, low grade, primary bone tumours arising from notochord remnants. They are rarely located in the lumbar spine and consequently, the literature is lacking about the condition. There are very few case reports on the technical aspects of resection of extensive lesions such as our case. Treatment can be potentially curative only if aggressive surgical resection is utilised. We describe a case of an extensive lumbar chordoma, and demonstrate the possibility of performing a staged anterior and posterior total tumour resection with planned transgression in conjunction with an expandable cage, vascularised rib, fibula and latissimus dorsi grafts for the treatment and reconstruction of extensive spinal disease with this condition.

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Section: Reconstructionmentioning

confidence: 99%

Section: Reconstructionmentioning

confidence: 99%

Section: Reconstructionmentioning

confidence: 99%

Section: Reconstructionmentioning

confidence: 99%

See 2 more Smart Citations

Extensive lumbar chordoma and unique reconstructive approach

Sivabalan

Mobbs

2011

Eur Spine J

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“…They are also effective in a variety of spinal pathologies, including large segmental defects and where spinal fusions have failed using other conventional methods, such as nonvascularised bone grafts [51,52].…”

Section: Fvfg and Arthrodesismentioning

confidence: 99%

Free vascularised fibular grafts in orthopaedics

Bumbaširević

Stevanović

Bumbaširević

et al. 2014

International Orthopaedics (SICOT)

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Bony defects caused by trauma, tumors, infection or congenital anomalies can present a significant surgical challenge. Free vascularised fibular bone grafts (FVFGs) have proven to be extremely effective in managing larger defects (longer than 6 cm) where other conventional grafts have failed. FVFGs also have a role in the treatment of avascular necrosis (AVN) of the femoral head, failed spinal fusions and complex arthrodeses. Due to the fact that they have their own blood supply, FVFGs are effective even in cases where there is poor vascularity at the recipient site, such as in infection and following radiotherapy. This article discusses the versatility of the FVFG and its successful application to a variety of different pathologies. It also covers the applied anatomy, indications, operative techniques, complications and donor-site morbidity. Though technically challenging and demanding, the FVFG is an extremely useful salvage option and can facilitate limb reconstruction in the most complex of cases.

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Fibula Free Flap Reconstruction of Cervical Spine Defects: A Multi‐Institutional Study

Yang,

Morton,

Colcord

et al. 2024

The Laryngoscope

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IntroductionCervical spine defects result in spinal instability, putting the spinal cord and vertebral arteries at risk of damage and possibly devastating neurological injuries. The fibula free flap can span the spinal defects for stability. There is a paucity of literature on this technique.MethodMulti‐institutional retrospective case series reviewing patients who underwent cervical spine reconstruction with a fibula free flap. Patient demographic information, comorbidities, characteristics of cervical spine defects, and free flap complications were collected.ResultsA total of 1187 fibula free flaps across 10 different institutions were reviewed. Thirteen patients (1.09%) underwent cervical spine reconstruction with a fibula free flap. Average age was 52.3 years old with an age range of 12–79 years. There were six males (46.1%) and seven females (53.8%). The most common defect etiology was infection (n = 6, 46.1%). Most commonly involved cervical spine level of the defect was C5 (n = 10) followed by C6 (n = 9) and C4 (n = 8). The majority of reconstructed defects spanned three or more cervical levels, (n = 9, 69.2%). Facial artery was the most common arterial anastomosis (n = 8). Eight patients (61.5%) required a tracheostomy during their postoperative course. None of the patients had symptomatic or radiographic nonunion.ConclusionThis case series demonstrates that a vascularized fibula flap is a potential reconstructive option for cervical spine defects, especially in defects greater than three cervical levels, in the setting of infection, and previously radiated patients.Level of EvidenceLevel 4 Laryngoscope, 2024

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The use of vascularized fibular grafts for the reconstruction of spinal and sacral defects

Abstract: Free fibula transfer for complex spinal reconstruction is a reliable means of obtaining bony union for complex lumbar or sacral resections where traditional bone grafting techniques may not be technically feasible.

Cited by 56 publications

References 52 publications

Extensive lumbar chordoma and unique reconstructive approach

Extensive lumbar chordoma and unique reconstructive approach

Free vascularised fibular grafts in orthopaedics

Fibula Free Flap Reconstruction of Cervical Spine Defects: A Multi‐Institutional Study

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