Vascularized Proximal Fibular Epiphyseal Transfer for Distal Radial Reconstruction

Innocenti, Marco; Delcroix, Luca; Manfrini, Marco; Ceruso, Massimo; Capanna, Rodolfo

doi:10.2106/00004623-200407000-00021

Cited by 120 publications

(69 citation statements)

References 14 publications

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“…The growth using a microvascular fibula might currently be the best solution for the longitudinal forearm development because these techniques have recently become apparently improved. 33,34 However, the reported complications (Innocenti M, personal communication) at donor site may be a contraindication for the use of proximal fibula at early age with this congenital indication, when the lower limb is developing. There is a risk for peroneal palsy or some permanent weakness in foot or toe extension and a risk of valgus deformity at the ankle.…”

Section: Discussionmentioning

confidence: 99%

Vascularized Metatarsophalangeal Joint Transfer for Radial Hypoplasia

Vilkki

2008

Seminars in Plastic Surgery

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The relatively new concept and technique of microvascular joint transplantation for the correction of the congenitally deformed wrist is presented with a series of 24 operated radial club hands. The results from the 19 upper extremities with a mean followup of 11 years show that the new technique will not diminish the longitudinal growth of the ulna. The ulna length in the series is now 15.4 cm in mean and will develop further and presumably better than that reported in the previous long-term studies after centralization. The superiority in wrist active mobility compared with those of some previous long-term studies is reported with total active motion of 83 degrees in mean. The radial deviation deformity has become increased by 12 degrees in mean in the long-term follow-up compared with the results reported previously by the same author in the series of the first nine patients in 1998. The balance in the growth between the supporting metatarsal joint and the distal ulna has remained satisfactory, and the resting radial deviation angle is 28 degrees in mean (range, 0 to 45 degrees) in the cases with successful joint transfer. A subluxation tendency in six of the transplanted joints is a new finding, and its prevention needs careful attention during the reconstruction. With respect to timing, the joint alignment and transplantation procedure is best performed between the ages of 2.5 and 4 years according to the current experience of the author. A pollicization is usually added after the wrist alignment procedure. This technique will give the child a period of $10 years without any new need for surgical treatment, and usually no splinting is needed during that period. However, an additional corrective osteotomy may be needed at early puberty depending on the growth properties of the joint graft and original ulna and because of ulnar bowing. The reported technique with preoperative and postoperative measures takes a period of about one-half year, and the whole procedure is considered quite demanding as far as an adequate preoperative soft tissue distraction and the microvascular joint transplantation are concerned. It is recommended that the treatment be performed in dedicated microsurgical centers with adequate pediatric tissue transfer experience.

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Section: Discussionmentioning

confidence: 99%

Vascularized Metatarsophalangeal Joint Transfer for Radial Hypoplasia

Vilkki

2008

Seminars in Plastic Surgery

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“…According to our personal experience and to a review of the literature, the anterior tibial vascular bundle seems to be the best choice to provide blood supply both to the epiphysis and diaphysis with a single pedicle. [15][16][17][18][19] This simplifies the surgical procedure and minimizes the ischemia time thus increasing the success rate.…”

Section: Discussionmentioning

confidence: 99%

“…All the patients underwent reconstruction by means of a vascularized autologous graft of the proximal fibula based on the anterior tibial artery. The harvesting technique has been described elsewhere 2,3 and consists of isolating the proximal fibula through an anterolateral approach taking care in preserving the anterior tibial vessels and their tiny vascular connections both to the diaphysis and the epiphysis. In five cases, the transferred fibula was fixed to the proximal radial stump, preferably by metal plate.…”

Section: Methodsmentioning

confidence: 99%

Vascularized Growth Plate Transfer for Distal Radius Reconstruction

Innocenti¹,

Delcroix²,

Balatri³

2008

Seminars in Plastic Surgery

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Distal radius reconstruction in children should meet two requests: restoration of some joint function and preservation of the physiologic growth of the segment. None of the conventional options is likely to successfully achieve both goals. Conversely, a vascularized transfer of the proximal fibula including the growth plate provides enough bone stock for diaphyseal reconstruction, an articular surface for joint function, and the potential for longitudinal growth. From 1992 to 2006, eight children ranging in age between 2 and 10 years underwent a vascularized transfer of the proximal fibula for distal radius reconstruction after bone sarcoma resection. The follow-up ranges were between 1 year and 15 years. All the grafts were harvested based on the anterior tibial artery. Seven cases with a follow-up longer than 2 years have been evaluated both clinically and radiographically. All the grafts survived and had a satisfactory growth after the transplant. The functional outcome has been satisfactory, and the range of motion of the reconstructed wrist has been nearly normal in all cases but one. Proximal fibular epiphyseal transfer was an effective procedure for distal radius reconstruction in children who underwent tumor resection. Refinements in the operative technique have increased the reliability of this reconstructive option, which might be safely used also in congenital and posttraumatic disorders.

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“…This flap has been successful for both proximal femur, as well as humeral and distal radial reconstructions. 7,8 When the defect only includes the cortex, the fibular graft can be used as an onlay graft. This method has been utilized in instances of radiation induced long-bone fractures.…”

mentioning

confidence: 99%

Free Vascularized Fibular Graft for Distal Tibial and Ankle Arthrodesis

Wallace

Devitt

Kreitz

et al. 2016

J Reconstr Microsurg Open

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The free vascularized fibular graft (FVFG) to the tibia was first described by Taylor et al in 1975. 1 Since then, the operation has evolved to include transfer of adjacent muscle, and in 1983 Chen and Yan described an osteocutaneous flap. 2 These advancements have provided a limb-sparing option to those patients once destined for amputation. Indications for these procedures now include trauma, chronic osteomyelitis, wide resection of malignant tumor, and pseudoarthrosis of long bones. 3Prior to the advent of these procedures, complex fractures of the tibia were treated with autologous, nonvascularized cancellous bone grafting. Nonunion and complication rates were high, often leading to delayed amputation. Nonvascularized fibular autografts also showed high complication rates and particularly high rates of nonunion and stress fractures. Attempts to reduce these complications led to the proposal for vascularized grafts. Free vascularized flaps have quicker Keywords ► free vascularized fibular graft ► ankle reconstruction ► limb salvage AbstractBackground The use of free vascularized fibular graft (FVFG) for proximal and midshaft tibial reconstruction is well documented in the literature. However, literature documenting distal tibial and proximal ankle reconstruction using this technique is lacking. The purpose of this case report is to demonstrate the osteocutaneous fibular free flap as a viable limb-sparing option to patients who previously required amputation in similar circumstances. Methods The patient is a 39-year-old man who sustained a traumatic distal tibial pilon fracture. He underwent open reduction and internal fixation, which was complicated by osteomyelitis requiring multiple debridements and ultimately, resection of necrotic tissue. The resulting distal tibial defect measured 12 cm, including the talus. In an attempt to salvage the extremity, an FVFG was performed using the contralateral fibula. The harvested fibula was inserted proximally into the intramedullary canal of the tibia and impacted distally into the talar dome. Results To date, the patient's postoperative course was notable for minor wound healing issues which resolved. Postoperative computed tomography confirmed fusion, allowing for weight-bearing and removal of the external fixator. Conclusion Reconstruction of distal tibial defects with ankle involvement is a challenging operation for orthopedic and plastic surgeons. We describe a case in which a 12 cm tibial defect in conjunction with a talar defect was successfully reconstructed with a free vascularized fibular graft. We believe that this is a safe and viable option for those wishing to avoid amputation.

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Vascularized Proximal Fibular Epiphyseal Transfer for Distal Radial Reconstruction

Cited by 120 publications

References 14 publications

Vascularized Metatarsophalangeal Joint Transfer for Radial Hypoplasia

Vascularized Metatarsophalangeal Joint Transfer for Radial Hypoplasia

Vascularized Growth Plate Transfer for Distal Radius Reconstruction

Free Vascularized Fibular Graft for Distal Tibial and Ankle Arthrodesis

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