Vascularized fibular transfer in longstanding and infected large bone defects

Area of Science:

• Orthopedic Surgery
• Reconstructive Surgery
• Limb Salvage

Background:

• Reconstructing large bone defects in infectious environments poses significant challenges for limb salvage.
• Factors like bacterial flora disturbance, resistance, and limited blood supply in scarred tissues complicate treatment.

Purpose of the Study:

• To evaluate the long-term outcomes of vascularized fibular transfers in treating large bone defects within an infectious environment.
• To assess the efficacy of this reconstructive method in challenging clinical scenarios.

Main Methods:

• Retrospective review of 26 patients undergoing vascularized fibular transfer for large bone defects.
• Analysis of defect locations, causes (trauma, osteomyelitis, non-union), graft size, and complications.
• Assessment of bone union and functional outcomes.

Main Results:

• 96% of vascularized fibular grafts achieved complete bone union.
• The average graft length was 16.6 cm, with a fasciocutaneous component in 16 patients.
• Complications included partial skin paddle necrosis (3 patients) and distal graft/pin tract infections (3 patients).

Conclusions:

• Vascularized fibular transfer is an effective treatment for large segmental bone defects in infectious environments.
• The procedure demonstrates a high success rate in achieving bone union, supporting its use in limb salvage.
• Careful management of potential complications is essential for optimal patient outcomes.