Length of Vascularized Fibula Graft Utilized and Union: Is There a Relationship?

Abstract

Since the introduction of vascularized fibula grafting using microvascular techniques by Taylor et al 1 in 1975, this technique has been used to treat several difficult conditions. Large skeletal defects greater than 5 to 6 cm resulting from trauma or resection of pathologic tissue (tumors, congenital pseudoarthrosis, osteomyelitis) have been treated successfully with vascularized fibula grafts. 2,3 Similarly, this technique has proven successful in achieving union in the treatment of nonunions, including recalcitrant atrophic nonunions and infected nonunions. 4-6 Union rates for vascularized fibula grafts for the abovementioned conditions have been reported in the literature. In one study, primary union was achieved in 84% of patients who underwent grafting for traumatic bone defect, nonunion, excision of tumor, excision of osteomyelitis, kyphoscoliosis, and congenital pseudoarthrosis. 3 A literature review of vascularized free fibula grafts in the treatment of nonunion of long bones reported primary union was achieved in 71.5%. 5 Overall, there is a fairly high rate of primary union. Furthermore, secondary union has been achieved with a second procedure in 15 to 20% of cases in some series. 2,5 This still leaves a significant number of patients that do not achieve union with the use of vascularized fibula grafting or require a subsequent operation. Few studies have looked