Reconstruction of large posttraumatic skeletal defects of the forearm by vascularized free fibular graft

Microsurgery (Impact Factor: 2.42). 01/2004; 24(6):423 - 429. DOI: 10.1002/micr.20067
Source: PubMed


Vascularized bone graft is most commonly applied for reconstruction of the lower extremity; indications for its use in the reconstruction of the upper extremity have expanded in recent years. Between 1993–2000, 12 patients with segmental bone defects following forearm trauma were managed with vascularized fibular grafts: 6 males and 6 females, aged 39 years on average (range, 16–65 years). The reconstructed site was the radius in 8 patients and the ulna in 4. The length of bone defect ranged from 6–13 cm. In 4 cases, the fibular graft was harvested and used as a vascularized fibula osteoseptocutaneous flap. To achieve fixation of the grafted fibula, plates were used in 10 cases, and screws and Kirschner wires in 2. In the latter 2 cases, an external skeletal fixator was applied to ensure immobilization of the extremity. The follow-up period ranged from 10–93 months. Eleven grafts were successful. The mean period to obtain radiographic bone union was 4.8 months (range, 2.5–8 months). Fibular grafts allow the use of a segment of diaphyseal bone which is structurally similar to the radius and ulna and of sufficient length to reconstruct most skeletal defects of the forearm. The vascularized fibular graft is indicated in patients with intractable nonunions where conventional bone grafting has failed or large bone defects, exceeding 6 cm, are observed in the radius or ulna. © 2004 Wiley-Liss, Inc. Microsurgery 24:423–429, 2004.

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    • "In our experience, the vascularized fibula is the best option in reconstruction of large bone defects in the forearm, especially if they are due to severe infection . It may sufficiently reconstruct the long bones of the forearm that would result in appropriate restoration of the relative length and motion of the ulna and the radius (prono-supination) [10] [11] [12] [13] [14] [15] [16]. Preservation of the fibula vascularity avoids osteocyte necrosis, often leading to bone resorption, and is indispensable for safer and quicker integration and healing of the bone graft. "
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