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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    • "yöntemi kullan›larak kemik transportu ile yap›lan distraksiyon osteogenezisi kaynamama için uygun bir seçenek gibi görünmekle birlikte son zamanlarda travma sonras› oluflan spesifik durumlarda ve baz› do¤umsal deformitelerde kullan›lmaktad›r.[16,17]Bu teknik, defektin 3 cm'i geçti¤i durumlarda tavsiye edilmemekte ve üst ekstremitede alt ekstremiteyle karfl›laflt›r›ld›¤›nda tekni¤in sinir felci aç›s›ndan için yüksek risk tafl›d›¤› bil- dirilmektedir.[18]Mikrocerrahi tekniklerindeki geliflmeler cerrahlar›n damarl› kemik greftlerinin transferini, atrofik kaynamamalardaki klasik sorunlar›n üstesinden gelmesini sa¤lam›flt›r . "

    Preview · Article · Jan 2012 · acta orthopaedica et traumatologica turcica
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    • "The hypertrophy is a slow process, requiring 1 to 2 years in the tibia and 2 to 3 years in the femur. Use of the VF alone is considered sufficient in the upper limb [32] [33] [34], but in the lower limb, especially in the femur, an additional support is recommended [35]. Ipsilateral VF transposition, a technique that is preferred by several authors for its simplicity, avoids microsurgical anastomosis of the peroneal vessels [36]. "
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    ABSTRACT: In 1988, the excellent results obtained with the use of vascularized fibular autograft as a salvage procedure in massive allograft failures caused by non-union or massive resorption prompted a trial of an original reconstructive technique for intercalary defects based on the primary combination of the two types of graft. The authors believe the excellent final results and the ability to avoid further salvage surgical procedures justify the primary application of this more complicated technique despite longer surgical times.
    Full-text · Article · Feb 2007 · Orthopedic Clinics of North America
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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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    ABSTRACT: Severe infections at the forearm level are difficult to treat not only in terms of sterilization but also in terms of functional restitution. Traditional radical debridement is very important, however, reconstruction of the excised tissues sometimes meets with difficulty when there is used of such conventional techniques. At the forearm level, local flaps generally are not sufficient in covering big defects. Conventional bone grafts may be resorbed or they cannot help healing when placed in infected and hypovascular tissue bed. Therefore, bone reconstruction is a real challenge. Development of microsurgical techniques has increased the possibilities of treatment when those severe infections occur. Reconstruction of large soft tissue defects can be achieved by choosing the appropriate free flap. Vascularized fibular grafts allow the use of a segment of diaphyseal bone which is structurally similar to the radius and the ulna, and of length that would suffice to reconstruct most skeletal defects. In the upper limbs the vascularized fibular graft is indicated for patients in whom conventional bone grafting has failed or large bone defects are present (extending beyond 5 cm). When contemporary soft tissue reconstruction is needed, the fibula may give osteocutaneous and osteomyocutaneous grafts to be transferred. We report the results of a series of 22 cases of severe chronic osteomyelitis of the radius and/or the ulna treated with free vascularized fibula bone grafts. All patients were reviewed at a mean follow-up of 3 years (10–93 months); in all cases the infection never recurred. We report only one bone resorption, in the case of a double-barrel fibular transfer, which probably occurred due to vascularization failure. Even in this case, the patient was able to resume previous occupation.
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