Treatment of large segmental bone defects with free vascularized fibular grafts

Abstract

From December 1988 to May 1996, transfer of free vascularized fibular graft was performed in 13 patients with large segmental bone defects. There were 12 males (92.3%) and 1 female (7.7%) with an average age of 21.2 years (6.5-29). 9 patients had gun-shot wounds (2 ulna, 7 tibia), 1 patient had a tibial defect after tumor resection, 1 had a post-traumatic nonunion in the humerus and 1 had osteomyelitis of the tibia. The mean time from the primary injury to vascularized fibular grafting was 17 months (1 month-78 months). Before free vascularized fibular transfer, 12 of the patients had been undergone various and unsuccessful operations to treat the primary pathology for at least once or more. The mean length of the defects was 8.7 cm (6 cm-16 cm). In the early postoperative period, we monitored the patency of anatomoses by observing the color of the island pedicle skin flab whose blood supply was in continuity with that of the fibular graft in 7 patients. We also confirmed the blood supply of the grafts by bone scintigraphy in the first week. The mean follow-up time was 25.2 months (4 months-95 months). Our rate of union was 77 % (10 of the 13 patients), and mean time of solid union was 5.4 months (4 months-7 months). We observed stress fracture in the grafts of the 5 patients. 4 of these fractures were treated by immobilization in cast and the other by grafting and internal fixation. The rate of the secondary operations for treatment of complications was 30.7%. None of the patients had any major donor-site morbidity. After one and a half year follow-up period, hypertrophy of the fibular grafts were seen in all the patients.