Free Vascularized Fibular Graft is Reliable in Upper Extremity Long-Bone Reconstruction with Good Long-Term Outcomes

Abstract

Background Free vascularized fibular graft is useful in upper extremity long-bone reconstruction. The authors studied the reliability and long-term outcomes of this technique. Methods The authors included 20 patients with a minimum follow-up of 24 months in this study, and retrospectively reviewed patients' hospital records and used a preinformation form, the Disabilities of the Arm, Shoulder and Hand (DASH), the Lower Extremity Functional Scale (LEFS), and the 15D health-related quality of life (HRQoL) instrument to perform a cross-sectional assessment. Results A total of 9 adults and 11 children underwent vascularized fibular transfer for radical tumor resection (n = 13), infection (n = 1), injury (n = 3), or secondary pseudoarthrosis (n = 3) in various locations of the upper extremity. The median follow-up period was 6 years. Six reoperations proved necessary: one early reanastomosis and five revisions with cancellous bone grafting to enhance union. Altogether, 19 of the 20 grafts survived: one graft failed due to infection. One arm was amputated due to tumor recurrence. The median duration of bone union was 12 months. One graft never achieved distal union, whereas another developed nonunion after a stress fracture. Ten patients completed the questionnaires, with a median of 15.3 years postoperatively. The results revealed functional capabilities ranging from no restrictions to significantly impaired, and an HRQoL comparable to that of an age-standardized general population. Conclusion The free vascularized fibular graft is viable in different age groups to reconstruct upper extremity long-bone defects in cases of radical bone resection, extensive injury, and diaphyseal pseudoarthrosis. The long-term outcomes support the use of this technique.

Single-cortex is better than double-cortex in fibula grafts for large tibia bone defect in a 2-year-old child

“…[ 3 ] This technique has been proved effective in many previous studies. [ 4 , 5 ] However, the side effect of this method in small patients is still questioned for many years. Abdul et al report 8 cases of fibular graft section in Malaysia.…”

Treatment of Complex Infected Non-union of Bone of the Upper Extremity by a Staged Approach: Debridement and Antibiotic Cement Followed by a Vascularized Free Fibula Flap

“…There has been several papers on the use of the vascularized free fibula in the treatment of upper extremity long bone defects most of these have been limited case series addressing a mixed bag of upper extremity defects including tumor resection, aseptic non-union and infected non-union of bone [14][15][16][17][18][19][20][21][22][23][24][25]. None have addressed solely the treatment of infected non-union of bone with particular reference to the surgical technique and outcome in detail.…”

Is Non-Vascularized Fibular Grafting an Effective Choice in the Treatment of Upper Extremity Pseudarthrosis?

“…In their study, Kessler et al (19) reported that the average ICGB amount obtained from subjects with a mean age of 44 years was 9 cm 3 (range, 5-12 cm 3 ) from the anterior and 25.5 cm 3 (range, 17-29 cm 3 ) from the posterior. Although the amount of graft taken is higher than the posterior, it is possible to come across reports of more blood loss (1).…”

“…Conventional cancellous bone grafts have commonly served to reconstruct bone defects smaller than 6 cm. However, larger defects and cases of impaired vasculature require biomaterials, endoprostheses, and vascularized bone transfer (2)(3)(4).…”