Reconstruction of tibia defects by ipsilateral vascularized fibula transposition

Segmental defects of the tibia after open fractures, sepsis and tumor surgery present a challenging problem. Similarly, tumor surgery often involves radical resections and multiple procedures and is frequently accompanied by irradiation or chemotherapy creating an avascular bed. The aim of this study is to report the results and discuss the role of the ipsilateral pedicle vascularized fibula (IPVF) a technique used for reconstruction of tibia defects.

Reconstruction of large tibia defects 6-22 cm due to tumor resection were performed in 5 patients by ipsilateral vascularized fibula transposition. The mean age of the patients was 35.4 years (19-42) SD 9.31. The mean follow-up was 59.6 months (24-96) SD 29.2. The mean length of the bone defect was 14.6 cm (6-22) SD 6.066 and the mean time for union was 8 months (6-12) SD 2.82. Arteriography was used preoperatively in all patients to evaluate the lower limb vasculature and to select the optimal surgical approach. The osteosynthesis was stabilized by a plate.

There was sound union in all cases. There were only two minor complications one partial paresis of peroneal nerve and one superficial infection. The mean follow-up was 59.6 months (24-96) SD 29.2. No patient presented with any complaints with the procedure and all had good functional results.

The procedure was technically simple compared to free vascularized fibula and could be performed in hospital with low resources. There are several advantages: (a) achievement of bone defect reconstruction retaining periosteal and endosteal circulation, (b) preservation of a major vessel of the lower leg, (c) avoidance of difficulty and risk of microvascular technique and (d) no donor-morbidity. We routinely recommend preoperative angiography and intraoperatively meticulous dissection to prevent damage to the vascular pedicle.