Free vascularized fibular graft for the treatment of a massive long-bone defect

Free vascularized fibular grafts were used for reconstruction of massive long bone defects in 10 cases. The causes of the defects included 3 congenital pseudarthroses of the tibia, 2 traumatic bone defects, and 5 bone tumors. The average graft length was 13.2 cm (range 6-21 cm). Follow-up ranged from 4-18 months, with a mean of 8.5 months. Seven cases established bony union at graft host junctions within 3 months. Two congenital pseudarthroses of the tibia exhibited recurrence of neurofibromatosis at the proximal graft-host junctions; one was complicated by infection and had not yet obtained bony union on the patient's most recent visit. In 2 cases of bone tumor, the malignant tumor recurred; one of these patients underwent a below-elbow amputation. Early results indicate that the vascularized fibular graft is a useful alternative for reconstruction of some large bone defects. Adequate removal of the underlying lesion is essential if this procedure is to be used for treatment of congenital pseudarthrosis or for filling in the bone after resection of a tumor.