Reconstruction of large limb bone defects with a double-barrel free vascularized fibular graft

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BI Zheng-gang(Department of Orthopedics,First Hospital,Harbin Medical University,Harbin,Heilongjiang 150001,China)
HAN Xing-guang(Department of Orthopedics,First Hospital,Harbin Medical University,Harbin,Heilongjiang 150001,China)
FU Chun-jiang(Department of Orthopedics,First Hospital,Harbin Medical University,Harbin,Heilongjiang 150001,China)
CAO Yang(Department of Orthopedics,First Hospital,Harbin Medical University,Harbin,Heilongjiang 150001,China)
YANG Cheng-lin(Department of Orthopedics,First Hospital,Harbin Medical University,Harbin,Heilongjiang 150001,China)
Journal Title:
Volume 121, Issue 23, 2008
Key Word:
fibula;graft;double;bone loss

Abstract: Background The use of a free,vascularized fibular graft is an important technique for the reconstruction of large defects in long bones.The technique has many advantages in strong,tubular bones; a more reliable vascular anatomy with a large vascular diameter and long pedicle is used,minimizing donor-site morbidity.Due to limitations in both fibular anatomy and mechanics,they cannot effectively be used to treat large limb bone defects due to their volume and strength.Methods From 1990 to 2001,16 clinical cases of large bone defects were treated using vascularized double-barrel fibular grafts.Patients were evaluated for an average of 10 months after surgery.Results All the patients achieved bony union; the average bone union took 10 months post surgery,and no stress fractures occurred.Compared with single fibular grafts,the vascularized double-barrel fibular grafts greatly facilitate bony union and are associated with fewer complications,suggesting that the vascularized double-barrel fibular graft is a valuable procedure for the correction of large bone defects in large,long bones in addition to enhancing bone intensity.Conclusions The vascularized double-barrel fibular graft is superior to the single fibular graft in stimulating osteogenous activity and biological mechanics for the correction of very large bone defects in large,long bones.Free vascularized folded double-barrel fibular grafts can not only fill up large bone defects,but also improve the intensity margin.Therefore,this study also widens its application and enlarges the treatment targets.However,in the case of bone deformability,special attention should be paid to bone fixation and protection of donor and recipient sites.

  • [1]Taylor GI,Miller GD,Ham FJ.The free vascularized bone graft.A clinical extension of microvascttlar techniques.Plast Reconstr Surg 1975; 55:533-544.
  • [2]Dautel G,Duteille F,Merle M.Use of osteocutaneous "double-barrel fibular flaps" in limb reconstruction:four clinical cases.Microsurgery 2001; 21:340-344.
  • [3]Malizos KN,Zalavras CG,Soucacos PN,Beris AE,Urbaniak JR.Free,vascularized,folded fibula transplantation.Handchir Mikrochir Plast Chir 1993; 25:33-38.
  • [4]Jones NF,Swartz WM,Mears DC,Jupiter JB,Grossman A.The "double barrel" free vascularized fibular bone graft.Plast Reconstr Surg 1988; 81:378-385.
  • [5]Kim SY,Kim YG,Kim PT,Ihn JC,Cho BC,Koo KH.Vascularized compared with non vascularized fibular grafts for large osteonecrotic lesions of the femoralhead.J Bone Joint Surg Am 2005; 87:2012-2018.
  • [6]Yazar S,Lin CH,Wei FC.One-stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities.Piast Reconstr Surg 2004; 114:1457-1466.
  • [7]Chang DW,Weber KL.Use of a vascularized fibula bone flap and intercalary allograft for diaphyseal reconstruction after resection of primary extremity bone sarcomas.Plast Reconstr Surg 2005; 116:1918-1925.
  • [8]Chen CM,Disa JJ,Lee HY,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 Reconstr Surg 2007; 119:915-926.
  • [9]Bernd L,Sabo D,Zahlten-Hinguranage A,Niemeyer P,Daecke W,Simank HG.Experiences with vascular pedicled fibula in reconstruction of osseous defects in primary malignant bone tumors.Orthopade 2003; 32:983-993.
  • [10]Malizos KN,Zalavras CG,Soucacos PN,Beris AE,Urbaniak JR.Free vascularized fibular grafts for reconstruction of skeletal defects.J Am Acad Orthop Surg 2004; 12:360-369.
  • [11]Chen MT,Chang MC,Cben CM,Chen TH.Double-strut free vascular fibular grafting for reconstruction of the lower extremities.Injury 2003; 34:763-769.
  • [12]Sakuraba M,Kimata Y,Iida H,Beppu Y,Chuman H,Kawai A.Pelvic ring reconstruction with the double-barrel vascularized fibular free flap.Plast Reconstr Stag 2005; 116:1340-1345.
  • [13]Ruhin B,Menard P,Ceccaldi J,Dichamp J,Bertrand JC.Double-barrel fibular free flap for mandibular reconstruction:beneficial alternative for dental implanted rehabilitation (5 cases).Rev Stomatol Chit Maxillofac 2006; 107:338-346.
  • [14]Chang YM,Tsai CY,Wei FC.One-stage,double-barrel fibula osteoseptocutaneous flap and immediate dental implants for functional and aesthetic reconstruction of segmental mandibular defects.Plast Reconstr Surg 2008; 122:143-145.
  • [15]González-Garcia R,Naval-Gías L,Rodriguez-Campo FJ,Munoz-Guerra MF,Sastre-Pérez J.Vascularized free fibular flap for the reconstruction of mandibular defects:clinical experience in 42 cases.Oral Surg Oral Med Oral Pathol Oral Radiol Ended 2008; 106:191-202.
  • [16]Berend KR,Gunneson E,Urbaniak JR,Vail TP.Hip arthroplasty after failed free vascularized fibular grafting for osteonecrosis in young patients.J Arthroplasty 2003; 18:411-419.
  • [17]Zhang CQ,Wang KZ,Zeng BE Xu ZY,Li HS,Jin DX,et al.Free vascularized fibular grafting for treatment of old femoral neck fractures.Chin Med J 2005; 118:786-789.
  • [18]Pederson WC,Person DW.Long bone reconstruction with vascularized bone grafts.Orthop Clin North Am 2007; 38:23-35.
  • [19]Ghert M,Colterjohn N,Manfrini M.The use of free vascularized fibular grafts in skeletal reconstruction for bone tumors in children.J Am Acad Orthop Surg 2007; 15:577-587.
  • [20]Muramatsu K,Ihara K,Shigetomi M,Kawai S.Femoral reconstruction by single,folded or double free vascularised fibular grafts.Br J Plast Surg 2004; 57:550-555.
  • [21]Muramatsu K,lhara K,Doi K,Shigetomi M,Hashimoto T,Taguchi T.Reconstruction of massive femur defect with free vascularized fibula graft following tumor resection.Anticancer Res 2006; 26:3679-3683.
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