[Combination of cancellous bone grafts and free microvascular bone transplantation in large osseous defects]

Fourteen autogenous vascularized fibular bone grafts have been performed. The indications for surgery were segmental bone defects 17 cm in length on average, seven times because of radical tumor resection (three malignant, two locally aggressive tumors) and seven times because of primary or secondary bone loss in trauma patients. Two free vascularized fibular grafts were done in the upper extremity, four in the femur and eight in the tibia. The results with a follow-up from one half to seven years show that all extremities could be saved with no recurrence of tumor or infection. All vascularized fibular grafts healed with a good functional result. With stable osteosynthesis (AO-plates and external fixateur) partial weightbearing was possible after three weeks, full weightbearing after 8 to 12 months. For the femur a plate or interlocking nail should be used and for the tibia an external fixateur. Additional cancellous bone grafting should be done in two stages.