Journal of Musculoskeletal Trauma

Free Vascularized Fibular Grafts for Treatment of Infected Nonunion of the Tibia: Hyoung Min Kim, Il Jung Park, Youn Soo Kim, Kee Haeng Lee, Chan Woong Moon, In Ho Jeong, Changhoon Jeong; J Korean Fract Soc 2006;19(2):163-169. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.163

PURPOSE
To analyze the result of free vascularized fibular grafting for treatment of infected nonunion of the tibia with radical bone and soft tissue defect.
MATERIALS AND METHODS
17 patients with infected nonunion of the tibia who underwent a reconstruction using free vascularized fibular grafting were reviewed retrospectively. The mean follow-up period was 70.3 months. We analyzed the results radiographically which included the time of bone union, the amount of hypertrophy of grafted bone and complications.
RESULTS
The average length of bone defect was 8.8 cm (5~15 cm), and the average length of fibular graft was 14.1 cm (10~17.5 cm). Bony union was achieved in 11 of 17 cases and the average time of bone union was 5.2 months (4~6 months). There were 6 cases of nonunion. All nonunions developed at the proximal end of graft in patients who underwent fixation using pin and external fixator. Union was eventually achieved in all cases in 6.0 months (5~8 months) after the cancellous bone graft and plate internal fixation. Hypertrophy of grafted bones with more than 20% developed only in 4 cases out of 17. There were 3 cases of stress fracture, however there was no recurrence of infection or serious donor site morbidity.
CONCLUSION
Free vascularized fibula grafting is one of the most effective reconstruction options for the infected nonunion of the tibia with radical bone and soft tissue defect. Strong internal fixation using plate and screws is required to reduce the rate of nonunion and stress fracture of grafted fibulas.

Citations

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Treatment Strategy of Infected Nonunion
Hyoung-Keun Oh
Journal of the Korean Fracture Society.2017; 30(1): 52. CrossRef

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Treatment of Large Bone Defect of Femorl Shaft with Vascularized Fibular Graft and Ender Nail: A Case Report: Song Lee, Dong Ki Ahn, Sung Wook Chun, Sun Young Chung, Hyun Soo Kim; J Korean Soc Fract 2003;16(3):340-347. Published online July 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.3.340

Abstract PDF: Vascularized fibular graft is one of the well accepted methods in the treatment of large bone defect of femoral shaft. But bone fixation with Ender nails through the same incision of bone graft has never been reported. We performed vascularized fibular graft and bone fixation with Ender nails through single medial skin incision and permitted physiologic stress. We achieved early radiologic union and medullary widening and the patient could return to work 9 months after the accident. We would like to report such an experience of treatment with the reference of literature.

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Vascularized Fibular Graft in the Treatment of Chronic Osteomyelitis of Long Tubular Bone: Kwang Suk Lee, Sang Won Park, Kyung Jo Woo, Jong Won Kim; J Korean Soc Fract 1997;10(2):365-370. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.365

Abstract PDF: Previous management of chronic osteomyelitis has included antibiotic therapy, radical debridement, skin-grafting, distant cross-leg flaps, and local muscle flaps. Each of these modalities of treatment has limitations. However, over the last 20 years, vascularized fibular bone grafts have proved to be a valuable method of reconstruction of skeletal defects in the extremities following both infected and uninfected skeletal nonunions unresponsive to conventional methodology. We evaluated the efficacy of vascularized fibular graft in the treatment of chronic osteomyelitis of long bone. From August 1988 to June 1995, fourteen cases of chronic osteomyelitis of long bone which were followed for an average of 3 years duration were treated by vascularized fibular graft at the Department of Orthopaedic Surgery, Korea University Hospital. The results were as follows; 1. Even if the long tubular bone infection was uncontrolled, vascularized fibular graft could be performed and it was highly resistent to local infection. 2. Twelve cases (85.7%) out of a fourteen cases had primarily obtained bony union. 3. Free vascularized fibular graft is significant and reliable porcedure of bone grafting for the treatment of chronic osteomyelitis of long tubular bones.

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Anterior transposition of vascularized fibula for the segmentaldefects of both tibias report of one case: Kwang Suk Lee, Jong Woong Park; J Korean Soc Fract 1992;5(1):150-156. Published online May 31, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.1.150

Abstract PDF: No abstract available.

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