The morbidity of the free vascularised fibula flap

doi:10.1016/0007-1226(93)90219-2

British Journal of Plastic Surgery

Volume 46, Issue 6, 1993, Pages 466-469

https://doi.org/10.1016/0007-1226(93)90219-2 Get rights and content

Summary

Twenty patients who had undergone free vascularised fibula flap transfers were reviewed to determine the incidence of peri and postoperative complications. The mean follow-up was 3.2 years (0.2–10); 18 grafts were successful, but required 10 re-operations for complications including 5 haematoma evacuations and 3 bone grafts and plates for delayed or non-union. The two unsuccessful fibula grafts required 11 re-operations, the majority for infections and non-union. Technical details of the operative procedure are reviewed for their part in the complications.

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Cited by (32)

Reconstruction of the Mandible
2017, Maxillofacial Surgery, 3rd Edition: Volume 1-2
Double-barrel fibular graft for metaphyseal areas reconstruction around the knee
2010, Orthopaedics and Traumatology: Surgery and Research
Citation Excerpt :
No donor-site morbidity such as secondary paresthesia of the peroneal nerve territory was observed. The only other complication was a systematic reduction in hallux flexion strength, without retraction [14]. EF was maintained for a mean 8.5 months (range, 4.9–13.6 months), relayed by leg brace for a mean 6.1 months with the knee mobilized.
The metaphyses around the knee (distal femoral and proximal tibial) are junction areas subject to considerable stress. Double-barrel free vascular fibular graft (D-FVFG) provides good bone augmentation and restores the metaphyseal cone; the present study assessed its capacity to restore metaphyseal anatomy and axis and investigated its impact on the neighboring knee joint.
Eight D-FVFGs performed for metaphyseal segmental bone defect were followed up for a mean 6.5 years (range, 3–14 years). There were seven femoral nonunions, five of which were septic, and one chondrosarcoma of the tibia. Osteosynthesis used an external fixator (EF) in six cases (four of which bridged the knee), a double plate on the tibia in one case, and intramedullary nailing of the femur in two cases, including one to replace an EF. Adjuvant bone graft was associated in six cases. A protective leg brace was maintained for a mean 16.0 ± 4.0 months. Three arthrolyses were required after final union.
Union was achieved in all cases, after a mean 6.4 ± 2.1 months. Sixty-four percent of defect volume was reconstructed. The immediate postoperative mechanical femorotibial angle was 180.3 ± 6.0° and 174.5 ± 5.7° at FU. Mean knee flexion was 96.9 ± 36.0° and extension −5.0 ± 10.0°. Three patients showed symptomatic arthritis at follow-up.
D-FVFG satisfactorily restored the anatomy of the metaphyseal area. EF knee bridging seemed to impair varus correction, on top of the systematic problem of stiffness. When possible, internal fixation in first intention or as EF replacement appears to be preferable. Arthritic deterioration of the knee is worsened by initial joint lesions and femorotibial varus.
Level IV. Type of study: retrospective.
Free vascularized fibular flap in distal radius reconstruction
2010, Chirurgie de la Main
Les transferts osseux vascularisés sont indiqués devant toute perte de substance osseuse qu’elle soit d’origine traumatique ou faisant suite à une résection tumorale. Le transfert de fibula vascularisé est particulièrement adapté à la prise en charge des pertes de substance étendues du radius distal de par son anatomie constante et son prélèvement relativement aisé. Il peut être utilisé sous différentes formes ce qui permet de s’adapter à la perte de substance à reconstruire : osseux pur, ostéomusculaire ou ostéocutané. Le segment osseux utilisable peut aller jusqu’à 25 cm. Chez l’enfant, il peut être transféré avec le cartilage de croissance pour permettre une croissance du transplant mais cela nécessite une double anastomose du pédicule tibial antérieur et fibulaire. Les séquelles au site donneur peuvent être considérées comme négligeables.
Free vascularized bone transfers are indicated to reconstruct large bone loss, either after traumatism or bone tumor resection. Free vascularized fibular transplant is particularly well designed for reconstruction of large defect of the distal radius. Anatomy is constant and harvesting is versatile and reliable. It may be used as bony transplant alone, osteocutaneous or osteocutaneomuscular. The length of the fibula harvested can be up to 25 cm. In children bone reconstruction, the proximal physis of the fibula can be transferred to allow secondary bone growth but there is a need for double anastomosis of the anteriotibial and the fibular bundles. Donor site sequelae are minimal.
Stress fracture of the tibia following a vascularised free fibular flap
2008, Journal of Plastic, Reconstructive and Aesthetic Surgery
Citation Excerpt :
Moreover, the flap cannot be used in a patient with a potentially ischaemic leg, peripheral vascular diseases, varicose veins, leg ulcers and peroneus magnus ulceration.11,12 Donor site morbidity ranges between 10 and 40%12,13 but is not severe enough to have an impact on patient's activities.14 Morbidities include wound infection, dehiscence, partial or complete skin graft loss, pain, ankle stiffness or instability, transient peroneal motor or sensory loss and compartment syndrome.15
A 49-year-old female presented with a T4 N2 Mo moderately differentiated squamous cell carcinoma of the right cheek mucosa and involving the mandible. Patient treatment included resection of the tumour with partial mandibulectomy, maxillectomy and a free osteocutaneous fibular flap to reconstruct the bony mandibular and soft tissue intraoral defects. Six weeks postoperatively the patient developed a stress fracture of the right tibia, a complication which has not been reported in the literature previously. Pre- and postoperative measures should be considered to avoid such a complication.
Gait analysis of donor leg after free fibular flap transfer
2008, International Journal of Oral and Maxillofacial Surgery
The purpose of this study was to demonstrate gait disturbance after fibular flap transfer using preoperative and postoperative gait analysis. The gait performance of 20 patients was assessed at the Laboratory for Biomechanics, Seoul National University Hospital. Kinematic and kinetic data were collected simultaneously while walking on a 25-m walkway. One month postoperatively, a significant (p < 0.05) decrease in the time-distance parameter as well as a significant (p < 0.05) decrease in the peak plantarflexion and dynamic range was seen. Only peak plantarflexion in swing was significantly (p < 0.05) decreased until 3 months postoperatively. On the basis of the gait analysis results, it was concluded that normalization of the patients’ gaits would be expected within 3 months after the operation. There were no permanent pathological changes in the donor site.
Principles of Bony Reconstruction
2005, The Mutilated Hand

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The morbidity of the free vascularised fibula flap

Summary

Br J Plast Surg

Injury

Br J Plast Surg

The free vascularised bone graft: a clinical extension of microvascular techniques

Plast Reconstr Surg

Microvascular anastomoses for bone grafts in the treatment of massive defects in bone

J Bone Joint Surg

Donor site morbidity following resection of the fibula

J Bone Joint Surg

Dual-fibular grafting for massive bone gaps in the lower extremity

J Bone Joint Surg (Am)

Free vascularised fibular grafts for congenital pseudarthrosis of the tibia

J Bone Joint Surg (Br)

Reconstruction of large skeletal defects by vascularised fibula transfer. Factors that influenced the outcome of union in 62 cases

International Orthopaedics