Efficacy of free fibula flap for reconstruction of post traumatic long bone defect: retrospective study of eighteen cases
Keywords:Free fibula flap, Post traumatic, Long bone defect, Vascularised bone
Background: Complex and segmental bone defects are common after resection of tumors and trauma involving long bones of the extremities. Free fibula flap is commonly practiced for complex oromandibular defects and bone reconstruction after sarcoma and bone tumor excision. But post traumatic bone reconstruction of extremities with free fubula is less commonly practiced and only reserved for long segmental reconstruction or as an alternative to distraction osteogenesis. We are presenting a retrospective analysis of surgical details and outcome of 18 cases with post traumatic long bone defect reconstructed with free fibula osteocutaneous flap.
Methods: 18 patients with post traumatic composite or segmental long bone defect which were reconstructed with free fibula osteocutaneous flap (FFOCF) between 2014 to 2018 are included in this study. Operative details, success rate, bone healing, functional outcome and complications are reviewed retrospectively.
Results: Success rate of flap surgery was 17/18 (94.44%). Bone gap was 6-17 cm and Skin paddle ranged from 10 cm × 8 cm to 15 cm × 10 cm. Bone healing, weight bearing outside cast and return to daily activity period were 8-16 weeks, 10-15 months and 12-18 months respectively. Non-union, malunion and stress fracture were noted in one,one and three patients respectively.
Conclusions: Free fibula flap is a reliable method for reconstruction of post traumatic complex and segmental long bone defects. Quality of bone healing is good enabling resuming to early weight bearing and daily activities and high success rate. Free fibula flap may be procedure of choice for reconstruction of such bony injuries with the microvascular surgical facilities.
Tideman H. Fibula free flap: A new method of mandible reconstruction. Int J Oral Maxillofacial Surg. 1990;19(1):61.
Wolff KD, Ervens J, Herzog K, Hoffmeister B. Experience with the osteocutaneous fibula flap: an analysis of 24 consecutive reconstructions of composite mandibular defects. J Cranio-Maxillofacial Surg. 1996;24(6):330–8.
Lin PY, Lin KC, Jeng SF. Oromandibular reconstruction: The history, operative options and strategies, and our experience. ISRN Surg. 2011;8:24-5.
Malizos KN, Nunley JA, Goldner RD, Urbaniak JR, Harrelson JM. Free vascularized fibula in traumatic long bone defects and in limb salvaging following tumor resection: comparative study. Microsurgery. 1993;14(6):368-74.
Wee C, Ruter D, Schulz S, Sisk G, West J, Tintle S, Valerio I. Reconstruction of extremity long bone defects with vascularized fibula bone grafts. Plast Aesthet Res. 2019;6:12.
Chen CM, Disa JJ, Lee H-Y, Mehrara BJ, Hu QY, Nathan S, et al. Reconstruction of Extremity Long Bone Defects after Sarcoma Resection with Vascularized Fibula Flaps: A 10-Year Review. Plast Reconstruc Surg. 2007;119(3):915–24.
Zhang, J, He WS, Wang C, Yan YG, Ouyang ZH, Xue J, et al. Application of vascularized fibular graft for reconstruction and stabilization of multilevel cervical tuberculosis. Medicine. 2018;97(3):e9382.
Song HR, Kale A, Park HB, Koo KH, Chae DJ, Oh CW, et al. Comparison of internal bone transport and vascularized fibular grafting for femoral bone defects. J Orthop Trauma. 2003;17(3):203-11.
Wong TM, Lau TW, Li X, Fang C, Yeung K, Leung F. Masquelet Technique for Treatment of Posttraumatic Bone Defect. Scientific World J. 2014:7:103-2.
Bumbasirevic M, Stevanovic M, Bumbasirevic V, Lesic A, Atkinson HDE. Free vascularised fibular grafts in orthopaedics. Int Orthopaed. 2014;38(6):1277–82.
Zaretski A, Amir A, Meller I, Leshem D, Kollender Y, Barnea Y, et al. Free fibula long bone reconstruction in orthopedic oncology: a surgical algorithm for reconstructive options. Plast Reconstr Surg. 2004;113(7):1989-2000.
Del Pino GJ, Del Valle EB, Grana GL, Villanova JF. Free Vascularized Fibular Grafts Have a High Union Rate in Atrophic Nonunions. Clin Orthopaed Rel Res. 2004;419:38–45.
Zhen P, Hu YY, Luo ZJ, Liu XY, Lu H, Li XS. One-Stage Treatment and Reconstruction of Gustilo Type III Open Tibial Shaft Fractures With a Vascularized Fibular Osteoseptocutaneous Flap Graft. J Orthop Trauma. 2010;24:745-51.
Panagiotis K, Christos T, Stamatis K, Nikolaos D. A Simple Treatment for a 15-cm Tibia Bone Defect: A Case Report of an Ipsilateral Vascularized Fibula Transfer. J Orthopaed Trauma. 2007;21(3):215-18.
Zhen P, Liu XY, Lu H, Li XS. Fixation and reconstruction of severe tibial shaft fractures with vascularized fibular grafting. Arch Orthop Trauma Surg. 2011;131:93-9.
Malizos KN, Nunley JA, Goldner RD, Urbaniak JR, Harrelson JM. Free vascularized fibula in traumatic long bone defects and in limb salvaging following tumor resection: comparative study. Microsurgery. 1993;14:368-74.
Yazar S, Lin CH, Wei FC. One-Stage Reconstruction of Composite Bone and Soft-Tissue Defects in Traumatic Lower Extremities. Plast Reconstr Surg. 2004;114(6):1457-66.
Singh P, Kalra G, Goel P. Reconstruction of post-traumatic long bone defect with vascularised free fibula: A series of 28 cases. Indian J Plast Surg. 2013;46(3):543.
Wei FC, El-Gammal TA, Lin CH, Ueng WN. Free fibula osteoseptocutaneous graft for reconstruction of segmental femoral shaft defects. J Trauma. 1997;43(5):784-92.
Minami A, Kasashima T, Iwasaki N, Kato H, Kaneda K. Vascularised fibular grafts. An experience of 102 patients. J Bone Joint Surg Br. 2000;82(7):1022-5.
González del Pino J, Bartolomé del Valle E, Graña GL, Villanova JF. Free vascularized fibular grafts have a high union rate in atrophic nonunions. Clin Orthop Relat Res. 2004;(419):38-45.
Petersen MM, Dorrit Hovgaard, Elberg JJ. Rechnitzer C, Soren Daugaard, AidaMuhic. Vascularized Fibula Grafts for Reconstruction of Bone Defects after Resection of Bone Sarcomas. Sarcoma. 2010;2010:524721.