Bony Hypertrophy in Vascularized Fibular Grafts
Lewis L Shi1, Rohit Garg2, Andrew Jawa3
1The University of Chicago Medicine, IL, USA.
Hand (New York, N.Y.)
|January 28, 2020
Summary
Vascularized fibula grafts (VFG) show significant hypertrophy, increasing in size over time after repair of large bone defects. This graft hypertrophy enhances healing and mechanical strength, making VFG a valuable reconstructive option.
Area of Science:
- Orthopedic surgery
- Regenerative medicine
- Biomaterials science
Background:
- Vascularized fibula graft (VFG) transfer is a key method for repairing large skeletal defects.
- VFG offers superior healing and strength compared to conventional bone grafts by avoiding creeping substitution.
Purpose of the Study:
- To evaluate the degree and pattern of graft hypertrophy in Vascularized Fibula Grafts (VFG).
Main Methods:
- Retrospective review of patient radiographs following VFG procedures.
- Measurement of graft cortex, intramedullary canal width, and adjacent bone dimensions.
- Analysis of changes in cross-sectional area, cortical area, intramedullary area, and graft width over time.
Main Results:
- Thirty patients with VFG in various limb locations were analyzed with a mean follow-up of 7.6 years.
- Average graft hypertrophy reached 254% early postoperatively and 340% later, with initial rapid increase followed by plateauing.
- Graft width increased but did not surpass adjacent bone width; intramedullary canal size increased in the late period. Upper and lower extremity grafts exhibited similar hypertrophy.
Conclusions:
- Vascularized fibula graft (VFG) hypertrophy is a significant factor contributing to its effectiveness in treating large skeletal defects.
- The study identified two phases of hypertrophy: early periosteal and later endosteal.
- Understanding these hypertrophy processes is crucial for optimizing functional outcomes, mechanical strength, and surgical planning in VFG reconstructions.
