Harvesting the free fibular graft: A modified approach

Abstract

Background:The conventional technique of free non-vascularized fibular grafting is attended with some amount of morbidity and a long scar. We report a technique with little interference to the surrounding soft tissues to harvest more than one-third of whole length fibula.Patients and Methods:Thirty four patients of average age 23.5 years (range 8 to 51 years) having various pathologies like simple bone cysts (n=9), fibrous dysplasias (n=6), giant cell tumors (n=7), fracture non-union (n=10) and aneurysmal bone cysts (n=2) were taken up for the study. The fibula were harvested by two separate incisions, 1 cm each at proximal and distal extent of proposed donor site for taking out of graft after elevating the periosteum circumferentially using a periosteum stripper. Compression bandage and above knee plaster immobilization was applied to reduce the dead space collection.Results:The mean followup is 34 months. The patients were evaluated clinicoradiology. Thirty three patients showed good results. One patient had fair result due to delayed wound healing from hematoma which was treated surgically.Conclusion:The approach of harvesting fibula suggested by author reduces donor site morbidity and is safer than conventional approach.

Treatment of tumor-like lesions in the femoral neck using free nonvascularized fibular autografts in pediatric patients before epiphyseal closure

“…38,39 Several recent studies have shown that FNFAs harvested by a minimally invasive technique had the same benefits as FNFAs harvested by the periosteum-preserving technique in the treatment of bone defects in children and adults. 40–42 In the above-mentioned studies, complete regeneration of the donor site after FNFA harvesting was obtained in most patients. In the present study, the FNFAs were harvested by the periosteum-preserving technique and positioned into the bone cavity after resection of the tumor-like lesions in the femoral neck.…”

Use of Nonvascularized Autologous Fibular Strut Graft in the Treatment of Major Bone Defect after Periprosthetic Knee Fracture

“…Complications when harvesting the fibular strut graft, such as common peroneal nerve damage, weakness of extensor hallucis longus, ankle instability, nonunion, and stress fracture have been reported [ 8 , 12 ]. In order to prevent intraoperative problems during fibular harvest, it is important to preserve at least 5 to 6 cm of the proximal and the distal parts of the fibula [ 12 , 14 ].…”

“…Retaining the distal fibula can prevent adverse effects on the distal tibiofibular syndesmosis and the ankle joint [ 15 ]. In addition, we feel that the biological approach for harvesting long free nonvascularized fibular graft as proposed by Mukherjee et al reduces donor site morbidity and is safer than conventional approach [ 8 ].…”

“…No tourniquet was used. The right fibula was harvested according to the technique described by Mukherjee et al [ 8 ]. By using two separate incisions, 1 cm each at proximal and distal extent of proposed donor site, a segment of single fibula appropriate for the defect to be bridged was taken from a safe area of the bone without jeopardizing the associated neurovascular structures and proximal and distal tibiofibular joints.…”

Strategies for large bone defect reconstruction after trauma, infections or tumour excision: a comprehensive review of the literature

“…Three different options of vascularized fibular graft have been developed: single vascularized fibular graft, double-barrel technique, and combined vascularized fibula and allograft reconstruction [ 4 , 35 , 36 ]. In adult patients, a fibular graft up to 25–26 cm can be harvested [ 21 , 37 ]. The proximal fibula and the lateral malleolus should be spared to maintain knee and ankle joint stability, protect the common peroneal nerve, and preserve weight-bearing capacity [ 9 , 21 , 33 , 35 , 37 ].…”