Vascularised fibular grafts for reconstruction of the femur

Yajima, Hiroshi; Tamai, Susumu; Mizumoto, Shigeru; Ono, Hiroshi

doi:10.1302/0301-620x.75b1.8421008

Cited by 86 publications

(43 citation statements)

References 5 publications

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“…6 Yajima et al treated 20 patients with large bone defects or established nonunion of the femur due to various causes by vascularised fibular grafts (mean length of the fibular grafts was 18.1 cm) achieving successful outcome in 19 of the patients. 7 They highlighted the need for special microsurgical techniques. More operative time, need for use of external fixator for holding alignment, weakness of the grafted fibula and difficulties with the monitoring flap of skin.…”

Section: Resultsmentioning

confidence: 99%

Reconstruction of complex distal femur open fracture with distal femoral locking plate and primary autologous free fibular graft

et al. 2017

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Background: Distal femur fractures are high velocity injuries which accounts for 7-10% of all femoral fractures. These injuries are complex injuries which are difficult to manage. Despite advances in techniques and implants, treatment remains a challenge, in many situations.Methods: We present a retrospective review of 8 cases, involved in high velocity road traffic accident who presented to emergency department at St. John’s Medical College, Bangalore, Karnataka, India between September 2011 to December 2015, with complex open fracture of the distal femur with bone loss. All were managed with initial wound debridement and skeletal traction. Subsequently fractured femur was reconstructed with distal femoral locking plate stabilization, along with autogenous non vascularised fibular graft and cortical-cancellous graft bridging the bone defect. Radiological union, functional outcome measured with Tegner and Lyslom scores, KOOS score and complications were assessed.Results: At average 5 years follow up, all the fractures have united well, with good functional outcome. X-ray showing united fracture with incorporation of the fibular graft. According to Tegner and Lyslom scoring, 6 patients had good rating, 2 had satisfactory rating. Average KOOS score was 82.15. Shortening of 2 cm and 4 cm in couple of patients was the major complication. Conclusions: Delayed primary surgery, using autologous non vascularised free fibular graft in conjunction with a locking compression plate, with autogenous cortico-cancellous graft is an effective, less technically demanding and cost effective means of reconstruction option to manage bone defects in complex open fractures of the distal femur. An overall acceptable results in terms of fracture union, fibular incorporation, adequate restoration of knee motion and early rehabilitation can be expected.

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Section: Resultsmentioning

confidence: 99%

Reconstruction of complex distal femur open fracture with distal femoral locking plate and primary autologous free fibular graft

et al. 2017

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“…Because of the length of the nutrient vascular pedicle, it is not possible to implant it in regions with larger soft tissue coating, because it does not reach the surface. 70 For this reason, Eisenschenk et al 18 question therefore the appliance of a skin island in the femur. Furthermore, Buyukdereli et al 18,64 doubt in their article the reliability of the skin island, because it does not always guarantee that the bone graft is also vital.…”

Section: Selection Of Postoperative Monitoring Techniquesmentioning

confidence: 99%

“…Cases had been published, in which a necrotic skin island had been accompanied by a sufficient blood circulation in the bone. 70,71 On the contrary, there have also been described cases of defects in the transferred bone graft still having a vital skin island. 66 One possible explanation is the excessive stretching of the vascular pedicle for example due to postoperative swelling, 70 resulting in a decreased blood flow.…”

Section: Selection Of Postoperative Monitoring Techniquesmentioning

confidence: 99%

Postoperative monitoring of free vascularized bone grafts in reconstruction of bone defects

et al. 2009

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Vascularized bone transfer is increasingly recognized as a very useful and versatile technique for reconstructing large bone defects. It is especially indicated in patients with challenging conditions, such as nonunions, postoncologic resections, severe trauma, and congenital defects. With increasing experience of reconstructive surgeons, improved microsurgical techniques, and more enhanced flaps, the failure rate of free flaps has been reduced in the last decades. Especially, the early-postoperative period is decisive in the outcome of surgery. Several techniques have been described for monitoring the postoperative viability of microsurgical free vascularized graft, and their sensitivity and reliability continues to be the object of animal experiments and clinical trials. The qualities of an optimal monitoring device should be objective, continuous, noninvasive, safe, reproducible, easily managed, and interpretable for the nursing staff, inexpensive, and a clear indicator of changes in arterial and venous circulation. Presently, no one neither fulfills all of the criteria completely nor is uniformly accepted. In this article, relative advantages and disadvantages of these various postoperative monitoring techniques are discussed.

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“…8,9 In this report, the use of vascularized fibular transfer for reconstruction of lower limb defects after tumor resection is evaluated as regards time to union, hypertrophy, functional outcome, and complications.…”

Section: à9mentioning

confidence: 99%

Microsurgical reconstruction of lower limb bone defects following tumor resection using vascularized fibula osteoseptocutaneous flap

2002

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This study included 25 patients with lower limb tumors who had wide local resection and reconstruction by vascularized fibula osteoseptocutaneous flap, and who had their surgery performed at least 24 months before the end of the study. The average age at operation was 23.5 years. Twenty-three tumors were malignant;16 were staged as high-grade sarcomas (stage IIA, stage IIB, and Ewing's sarcoma). Tumor volume averaged 293.2 cc (range, 41.4-860). The resulting defect after tumor resection averaged 16 cm (range, 9-20 cm). The fibula was inserted as a single strut in 21 patients, and as a double-barrel construct in 4 patients. Fixation was augmented by interlocking nail in 11 cases, bridge plate in 9 cases, and external fixator in 5 cases. Twenty-four (96%) flaps survived. All grafts united in an average period of 4.5 months (range, 3-8 months) after transfer. Two secondary procedures were necessary to achieve graft union. Full weight bearing was possible after an average period of 7.5 months (range, 5-14 months). Significant hypertrophy (> or =30% of original fibular diameter) occurred in 85% of patients after an average period of 10 months from the index operation. In the latest follow-up radiographs (mean, 32 months), the degree of hypertrophy averaged 90% (range, 30-200%). Graft fracture occurred in three patients, and all healed conservatively. The Musculoskeletal Tumor Society rating score (MTSRS) averaged 21.2 points at the end of the first postoperative year, and 23.6 at the end of the study.

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Vascularised fibular grafts for reconstruction of the femur

Cited by 86 publications

References 5 publications

Reconstruction of complex distal femur open fracture with distal femoral locking plate and primary autologous free fibular graft

Reconstruction of complex distal femur open fracture with distal femoral locking plate and primary autologous free fibular graft

Postoperative monitoring of free vascularized bone grafts in reconstruction of bone defects

Microsurgical reconstruction of lower limb bone defects following tumor resection using vascularized fibula osteoseptocutaneous flap

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