The authors propose a minimally invasive technique for harvesting a free fibular graft. Fibular grafting is a common procedure in orthopedic practice. Fibula osteocutaneous free flap dissection video youtube. Modified surgical techniques of free vascularized fibular. Nowadays, advanced chemotherapy and surgical techniques made limb salvage possible, and.
Of these options, free vascularized fibular graft fvfg is the treatment of choice for its structural and vascular support within the femoral head. The fibula s anatomy lends itself to this procedure, where the bone is long and straight, and its vascular supply is radially directed. Vascularized fibula graft for humeral reconstruction. Nevertheless, there are few reports in the literature dealing with this procedure and surgical technique remains unclear. The technique presented is a safe and reliable method for treatment of nonunions of the proximal humerus using an inlay fibular strut allograft, compression through the nonunion site with heavy suture, and secure fixation with a fixedangle locked plate.
Surgeons have the option of harvesting both fibulas to cover a single defect. Free fibula graft to the hip for i avascular necrosis ree fibula grafting to the hip is contem plated as treatment for avascular necro sis avn of the femoral head. Im a 33 year old male and was just diagnosed with avn of the hip. Severe spondylolisthesis has been treated with the use of fibular strut grafts for the fusion of l5 and s1. The treatment of spondylolisthesis can be highly individualized. All patients had evidence of moderate to severe local osteoporosis and had a bone gap ranging from 4 to 20 mm. The surgical technique included the use of a nonvascularized autologous fibular strut graft as an augmentation technique in conjunction with double plating fixation. Novel doublestrut fibula ankle arthrodesis for large. Bone grafting is the surgical procedure in which new bone bone graft or a replacement material graft. Pedicled vascularized fibular graft with ilizarov external. Clinically, patient presented a painless aligned knee 12 months after femur fixation, although she was not able to return to an independent level of activity. The various techniques which have been used include.
Free vascularized fibular graft as a salvage procedure for. The conventional technique of harvesting fibular graft by long incision results in increased morbidity and a long scar, 1 3 weakness of extensor hallucis longus and ankle instability particularly when the required graft is long and extended into distal third. Modified technique for dowel fibular strut graft placement. The fibula is approached through a lateral incision simultaneous to the hip approach. Minimally invasive harvesting of nonvascularized fibular. Kwires were used by several authors to joystick the fragments and achieve graft position. The freeflap fibula graft was first described by taylor and miller in 1975 4 where the technique was developed to salvage two legs which would otherwise have been amputated and was the first successful distant transfer of a composite fibula graft by microvascular anastomoses to be reported by man.
I was diagnosed this week by a rhuematologist, and he has referred me to an orthopedic doctor who i see. The free vascularized fibular grafting fvfg has been shown to support the subchondral architecture as well as restore local circulation for the necrotic femoral head in treatment of onfh. Microsurgical vascularized fibular grafts for avascular. Our elearning platform contains high resolution images and a certified cme of the epiphyseal fibula transfer to proximal humerus following resection for osteosarcoma surgical procedure. Its dimensions allow it to anatomically match forearm defects, and it can be fitted into the medullary canals of the larger long bones humerus, femur and tibia. The average length of harvested fibular grafts was 73 mm range, 22190 mm, which represented 28. Regeneration of the fibula using a periosteumpreserving. Large bony defects in the middle or distal third of the tibia resulting from surgical resection of malignant bone tumors present a difficult reconstructive challenge. Microsurgery fibula flap harvest from the posterior. The fibula is extremely well suited as a graft and is considered to be a longbone flap. The hypothesis was that the use of fibular strut allografts in treating proximal humerus fractures with orif will provide low reoperation rates with acceptable outcomes. A new technique to enhance bone union in children article in journal of pediatric orthopedics 323. Due to the limitation of thickness of the thin fibula, sufficient stability cannot be obtained with one piece of fibular graft. Osteoseptocutaneous fibula flap harvest from the posterior approach for mandibular reconstruction.
Free vascularised fibular grafts in orthopaedics ncbi. Fibula osteocutaneous free flap dissection surgical video. Although many treatment options exist, results have been mixed with no definitive surgical technique identified. Fibular strut graft augmentation for open reduction and internal fixation of proximal humerus fractures. The vascularized fibula flap was first described in 1975 by taylor and colleagues. Vascularized fibula grafts for reconstruction of bone. Background the use of free vascularized fibular graft fvfg for. This report aimed to present the clinical results of the use of a modified surgical technique of fvfg for treatment of onfh. In these cases, we offer an approach that we pioneered free vascularized fibular graft which allows younger patients to delay or possibly eliminate the need for hip replacement in the future. Free vascularized fibular bone graft joint replacement. Proximal tibial reconstruction with auto transplantation. Learn the epiphyseal fibula transfer to proximal humerus following resection for osteosarcoma surgical technique with step by step instructions on orthoracle. Minimally invasive harvesting of nonvascularized fibular graft in. Avn is a condition in which blood flow to the bone is restricted, causing that portion of the bone to.
Idiopathic avascular necrosis of the femoral head treated. We evaluated the results of limbsparing surgery and reconstruction of bone defects with vascularized fibula grafts in 8 consecutive patients mean age at operation. The literature covers techniques using the fibula as a substitute for tibial reconstruction due to bone loss after trauma 1,2, osteomyelitis, excision of tumours 3 and congenital ceformities 4. Two publications 14,17 similar to our technique placed sutures into the rotator cuff for control and fixation of the tuberosities. Tumors of the proximal tibia, in children, can affect the growth plate and pose a challenge to further reconstruction of the bone defects resulting from tumor resection. Preoperative planning for fvfgs begins with the exclusion of patients with peripheral vascular disease, deep venous. During free vascularized fibular graft surgery, a section of fibular bone with attached artery and veins is harvested and transferred to the femoral head, which has been cored out to remove necrotic bone. Lateral window surgical techniques for sinus elevation 7. Campanacci and zanoli 5 described a fibula pro tibia technique with fibular 18 fixation to the pseudarthrosis site. We present a new surgical technique of bone reconstruction, based on the transposition of the ipsilateral fibula with its growth. Starting above the proximal tibiofibular joint, the incision bends to the anterior tibial crest and down along it, bending again medially a few inches below the previously planned fibular osteotomy fig. The bone defects reconstructed were proximal femoral diaphysis. Improved technique has led to complication rates, including donorsite morbidity, statistically similar to that of nonvascular fibular grafts.
Urbaniak, md, covers introduction, incision planning, hip exposure and vascular vessel isolation, harvest fibular graft, core decompression, fibular graft. Vascularized fibula graft is a good option for large humeral defects resulting from trauma, tumor resection, or infection and for smaller defects where enhanced blood supply is necessary for healing. In these cases, reconstructive procedure using a free vascularised fibular graft can be performed. Free vascularized fibular grafts for reconstruction of. Vascularised fibular grafts vfgs are a valuable surgical technique in limb salvage after resection of a tumour.
The fibula was removed subperiosteally by two or three small incisions in five patients with a mean age of nine years and nine months. Free vascularized fibular graft for distal tibial and ankle arthrodesis. This procedure can be coupled with in situ arthrodesis 59 andor anterior and posterior fusions. It is long and straight, has good bone mass, a tricortical profile and can be up to 3 cm x 40 cm in size. The main indications for this graft are defects larger than 5 to 6 cm or with poor vascularity of the surrounding soft tissues. Twentytwo patients with a complex nonunion of the shaft of the femur, humerus, or tibia were managed with a free autologous fibular strut graft for intramedullary fixation with use of closed or open methods. Bone grafting is the surgical procedure in which new bone bone graft or a replacement material graft substitute, is placed into bone fractures or bone defects to aid in healing. To overcome this problem, a doublebarrel vfg is usually needed. Lubek, in maxillofacial surgery third edition, 2017. In this case, we describe a novel modified technique used for distal tibia and. Peroperative photograph of minimal invasive operation technique of harvesting nonvascularized free fibular graft showing a the small proximal and distal. This reconstruction method is more complex regarding its surgical technique compared to tumor arthroplasty or unilateral fibular graft and has been repeatedly described in detail 4, 20, 25, 27, 28.
The results of 26 vascularized free fibula flaps with or without a skin paddle that were used for mandibular reconstruction is presented. Mandible reconstruction with free vascularized fibula. The purpose of this surgical technique article was to describe the biomechanically validated anatomic reconstruction of the fcl using a semitendinosus graft. The vessels in the fibula graft are then microsurgically anastamosed to donor vessels at the hip. We describe here technical points and results for 2 patients.
Free vascularized fibular grafting for the treatment of. Free vascularised fibular graft in multioperated patients for an. With the patient on supine position, a single incision is used. Detailed preoperative planning, experience in microvascular techniques, and careful postoperative followup are necessary to minimize complications and improve outcome. In the past decades, belowknee bk ablation was the standard treatment for malignant bone tumors and for local recurrences of aggressive bone tumors of distal tibia. Anatomic fibular collateral ligament reconstruction. Fibular grafting for postcollapse osteonecrosis of the femoral. The donor site was closed directly in 2 cases and with an abdominal fullthickness skin graft in 24 cases.
The fibular collateral ligament fcl is an important stabilizer of the lateral side of the knee through the whole range of motion. Free fibula graft association of surgical technologists. The ipsilateral fibula is positioned into the tibial defect and only the vessels of the contralateral fibula have to be anastomosed in. Free vascularised fibular graft in multioperated patients for an aseptic nonunion of the humerus with segmental defect. Various methods of reconstruction are available, such as allografts, vascularized fibular graft either free or pedicled, or endoprothesis replacement for distal defects.
A two team approach is recommended, with one raising the fibular flap and the other. Pdf fibular strut graft augmentation for open reduction. Bone grafting is in the field of interest of many surgical specialties, such as. Reconstruction methods do not always compensate the potential for bone growth in this segment. There was a significant relationship between the outcome of the grafting procedure and the etiology of the osteonecrosis p 0. Use of nonvascularized autologous fibular strut graft in. Fibular strut graft augmentation for open reduction and. Tibialization of the fibula in the treatment of severe. Avascular necrosis of the hip frequently occurs in people between the ages of 20 to 35, ages at which hip replacement may not be the best option. The distal tibia is an uncommon site of occurrence for primitive bone tumors, there are no large series covering this issue 1,2,3. When the length of one vfg is not sufficient, double struts of vfg reconstruction from the ipsilateral and contralateral legs provide long and strong grafts. Pdf the vascularised fibular graft for limb salvage.
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