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PubMed2004

[Distal fibula reconstruction using a frozen allograft: a case report].

We report the case of a 25-year-old woman who developed recurrent chondromyxoid fibroma involving the distal portion of the right fibula. This patient had been treated two years earlier with curettage without grafting. The treatment associated en bloc resection of the distal 12 cm of the fibula and reconstruction with a cryopreserved allograft fixed with a lateral plate and pin associated with a syndesmodesis screw for six weeks. The lateral collateral ligament and the tibiofibular ligaments were also repaired. At two years, the patient has no sign of recurrence and the ankle motion is satisfactory. The ankle is stable and pain free with an esthetic aspect similar to the healthy side. Allograft reconstruction is a novel alternative for reconstruction of the distal fibula. We have found only one other case reported in the literature.

Adult↗
PubMed2000

Functional development of the donor leg after vascularized fibula graft in childhood.

PURPOSE: To evaluate the effect of free vascularized fibula grafts on developing donor leg function, the authors reviewed their experience of procedures performed in children. METHODS: Over a 10-year period, 30 children (average age 7.2 years, without gender concern) underwent fibula harvest via an anterolateral approach. Graft length averaged 6.0 cm. Follow-up averaged 8 years. RESULTS: No vascular injury or shank dysplasia ensued. Neural injury occurred in 8 patients: to the profound peroneal nerve in 1 and to the superficial peroneal nerve in 7. Symptoms resolved spontaneously at 3 to 5 months in 6, but persisted in 2 patients in the latter group at 8 years' follow-up. Of 24 children who underwent rapid walking (200 m) followed by immediate stair climbing (50 steps), 2 (whose grafts were longer than average) had slight and 1 had obvious ankle pain. However, muscle strength and range of motion in the donor ankle were no different from values in the recipient leg in the 24 cases. X-ray findings showed that, with growth, the remaining 2 fibular segments in the donor leg became longer, but the length of the gap between did not change. Thus, the gap left by harvest became relatively shorter long after operation, benefiting the stability of the ankle joint in adulthood. CONCLUSION: Unlike free vascularized fibula grafts performed in adulthood, from which serious complications to the donor leg have been reported, the procedure performed in childhood appears not to have an adverse effect on functional development.

Child↗
PubMed2003

Bone response to unloaded titanium implants in the fibula, iliac crest, and scapula: an animal study in the Yorkshire pig.

The reconstruction of extended maxillary and mandibular defects with prefabricated free flaps is a two stage procedure, that allows immediate function with implant supported dentures. The appropriate delay between prefabrication and reconstruction depends on the interfacial strength of the bone-implant surface. The purpose of this animal study was to evaluate the removal torque of unloaded titanium implants in the fibula, the scapula and the iliac crest. Ninety implants with a sandblasted and acid-etched (SLA) surface were tested after healing periods of 3, 6, and 12 weeks, respectively. Removal torque values (RTV) were collected using a computerized counterclockwise torque driver. The bicortical anchored 8mm implants in the fibula revealed values of 63.73 Ncm, 91.50 Ncm, and 101.83 Ncm at 3, 6, and 12 weeks, respectively. The monocortical anchorage in the iliac crest showed values of 71.40 Ncm, 63.14 Ncm, and 61.59 Ncm with 12 mm implants at the corresponding times. The monocortical anchorage in the scapula demonstrated mean RTV of 62.28 Ncm, 97.63 Ncm, and 99.7 Ncm with 12 mm implants at 3, 6, and 12 weeks, respectively. The study showed an increase of removal torque with increasing healing time. The interfacial strength for bicortical anchored 8mm implants in the fibula was comparable to monocortical anchored 12 mm implants in the iliac crest and the scapula at the corresponding times. The resistance to shear seemed to be determined by the type of anchorage (monocortical vs. bicortical) and the length of the implant with greater amount of bone-implant interface.

Animals↗
PubMedDate not supplied

[Femur-fibula-ulna (FFU) complex in the 33rd week of gestation: ultrasonography, radiology, pathology and differential diagnosis. Case report].

We present a case of a 27 year old I. gravida, I. para. Despite of regular ultrasonographic examination the diagnosis of skeletal malformation at the fetus was not before 33. weeks of gestation. It was the rare type of a bothside femur-fibula-ulna (FFU) complex. The FFU-complex is a no lethal malformation with typical unilateral combination from defects of femur and fibula, with contralateral defect of ulna. Dependent to involvement of malformated limbs the FFU-complex is classifiable in four groups. Only in 10 % all limbs are affected. Our case (type IV) showed a peromelia of both upper limbs with stumps of humeri, bothside aplasia of fibula and missing from 4. and 5. toes. There fetus were without nonlimb congenital abnormalities. The etiology of FFU-complex is unknown, the occurrence sporadic. There are never found genetic abnormalities. Familial recurrence is not described. There is no maternal or paternal age effect on FFU-complex. The differential diagnosis must include malformations with reduction anomalies of extremities, like thalidomide syndrome, splenogonadal fusion with limb malformations, Roberts syndrome, oroacral complex or acheiropodia. Mark off are amniotic band too.

Abnormalities, Multiple↗
PubMed2004

Corrective valgus osteotomy after free vascularized fibula transfer for the treatment of osteomyelitis at the neck of the femur: case report.

Reconstruction using a free vascularized fibula was performed on a long bony defect after osteomyelitis of the proximal femur. For this type of bone defect, a double-barrel fibular graft is recommended. The authors used this procedure for a 58-year-old male who had osteomyelitis of the left proximal femur. As osteotomy through a transplanted fibula can be safely performed, abduction osteotomy should be considered when coxa vara remains after reconstruction with a free vascularized fibula transfer.

Femur Neck↗
PubMed2005

Devascularizing complications of free fibula harvest: peronea arteria magna.

The authors present a case report of devascularizing complications following free fibula harvest. A retrospective review of 93 consecutively imaged limbs demonstrated a peronea arteria magna (PAM) prevalence of 5.3 percent in an urban population, which was used to perform a cost-effectiveness analysis for preoperative vascular imaging of the donor limb using magnetic resonance angiography (MRA) and traditional angiography (TA). Donor-site complications of fibula harvest range from 15 to 30 percent, but are rarely limb-threatening. Limb loss is a dreaded complication of congenital PAM, which can be present with a normal vascular exam. Some microsurgery groups advocate using no preoperative imaging of the donor limb; they rely on intraoperative assessment of the vascular anatomy. An aborted harvest due to aberrant anatomy leads to both direct and indirect added costs. The authors believe that MRA imaging of the donor limb, being minimally invasive, is cost-effective and indicated for free fibula transfers. For equivocal results, conversion to more invasive and costly TA may be necessary.

Adult↗
PubMed2007

Free fibula transfer in the treatment of difficult distal tibia fractures.

Management of the high-grade open distal tibia fracture remains problematic. The authors reviewed the charts of 14 cases of distal tibia and tibial plafond fractures reconstructed with a free fibula transfer. Six cases involved a plafond defect, and the fibula was used to arthrodese the tibio-talar joint. Seven cases included a skin paddle. Three of the four patients with osteomyelitis cleared their infection. Twelve patients went on to osseous union, and two were ultimately treated with amputation. Patients who went on to union had an average of 1.1 subsequent procedures, began full weightbearing in an average of 5.8 months, and were weightbearing without any assistive devices by an average of 8.5 months. There was no significant correlation between the time to full weightbearing and either the presence of infection or the length of the original defect. In this series, 86 percent success was obtained when a free fibula transfer was used either to bridge a tibial non-union or to promote arthrodesis of the tibio-talar joint.

Adult↗
PubMed1999

Mandibular reconstruction in children using the vascularized fibula.

In this study, the authors review their experience with vascularized fibula transfers for mandibular reconstruction in children. They outline the indications for such reconstruction, their method of contouring the fibula to accurately resemble the resected mandible, reconstruction of the temporomandibular joint, and the use of vascularized muscle for the management of associated soft-tissue deficiencies. Ten consecutive patients, 5 to 17 years of age and undergoing this procedure, were assessed from a medical, dental, radiographic, and photographic standpoint. The fibulae were elevated via a lateral approach, osteotomized, as required, and fixation was achieved with titanium miniplates and screws. All transfers survived, with viability confirmed by early postoperative bone scanning. Five patients had temporomandibular joint reconstruction, and five patients required simultaneous reconstruction of soft-tissue defects with associated vascularized muscle. The postoperative follow-up ranged from 3 to 30 months The occlusion of the remaining dentition, mandibular symmetry and projection, adequacy of lining and skin cover, and maximal mouth opening were reassessed. Occlusion was class 1 in all patients, and free-flap stability and function were in the normal range. However, soft-tissue contour was a problem. All wounds healed primarily without donor-site complications and with minimal recipient-site complications.

Adolescent↗
PubMedDate not supplied

[The ankle joint in fibula malformations].

The ankle joints of 109 extremities with fibula reductions wer examined. The authors' findings led them to conclude that the shape of the ankle joint must be regarded as the result of an adaptation to altered functions. Ball-shaped ankle joints are frequently found in cases of hypoplasia of the fibula; partial and subtotal aplasias of the fibula are more likely to be associated with a valgus deformity of the ankle joint (known as Volkmann's ankle joint deformity) or, if more severe, with kyphosis of the tibia. If there is no laterodorsal restraint by coarse fibrous strands in cases of fibular aplasia, it is also possible that ball-shaped ankle joints will develop.

Adolescent↗
PubMedDate not supplied

Intra-operative acute leg ischaemia after free fibula flap harvest for mandible reconstruction.

Osteosarcomas of the cranial bones need a large surgical radical resection. The best option to reconstruct mandible defect after resection is the free fibula flap. In our patient an acute ischaemic leg occurred just after the free fibula flap harvest for mandible reconstruction. The abnormal distribution of the calf arteries leads to catastrophic consequences. The peroneal artery could be the main dominant artery of the leg in a small number of patients. We reported an extremely rare case of "peronea magna", described in less than 0.2% of the global population. A careful pre-operative workup of the calf vessels is required in all the patients who need free fibula flap harvest.

Adult↗
PubMed2000

Reconstruction of a tibial defect with microvascular transfer of a previously fractured fibula.

A 43-year-old man sustained severe injuries to his lower limbs with extensive soft-tissue damage and bilateral tibial-fibular fractures. Acutely, the patient underwent external fixation and a free latissimus dorsi flap for soft-tissue coverage of the left leg. However, the tibia had a nonviable butterfly fragment that left a 7-cm defect after debridement. Subsequently, the contralateral fractured fibula was used as a bridging vascularized graft for this tibial defect. The transfer of a fibula containing the zone of injury from a previous high-energy fracture has not been reported. This case demonstrates the successful microvascular transfer of a previously fractured fibula for the repair of a contralateral tibial bony defect.

Adult↗
PubMed2001

Diastasis with low distal fibula fractures: an anatomic rationale.

Tibiofibular diastasis occurs infrequently in displaced ankle fractures that include a low fibula fracture. This is because the interosseous ligament, the major ligament resisting diastasis, lies above the level of the fracture. The anatomic study of the syndesmotic complex of the ankle reported here showed that the interosseous ligament has a variable attachment on the fibula, differing between specimens in its distance above the synovial reflection or joint line. Although most specimens had attachments approximately 1 cm or greater above the joint line, one of 18 specimens attached just above the synovial reflection. In such a case, a low fibula fracture would disrupt the interosseous ligament, which explains the anatomic basis for the infrequent diastasis in these ankle fractures.

Accidental Falls↗
PubMed1996

Posterior plating of displaced Weber B fibula fractures.

This is a prospective study that examines 32 patients who were treated with posterior plating of a displaced Weber B fibula fracture and had a minimum of 1 year follow-up. The surgical technique included application of an unbent one-third tubular plate to the posterior aspect of the fibula using the antiglide technique. Twenty-seven fractures were classified as supination-eversion IV: 13 with deltoid disruption and 14 with a medial malleolar fracture. Three were classified as pronation-abduction and two as low pronation-eversion fractures at the level of the plafond. A six-hole plate was used most often (18 cases), and 23 patients had a lag screw placed through the plate. There were no nonunions or malunions. No wound complications, screw loosening, loss of fixation, intraarticular screws, or palpable screws were found. Four patients had transient peroneal tendinitis that resolved in 4-8 weeks. Two patients had later plate removal caused by poor technique because of a symptomatic lag screw. Twenty of the 21 patients who returned a questionnaire were satisfied with their result (95%). Posterior fibular plating offers many advantages over lateral plating, including the possibility of no intraarticular or palpable screws and an improved and stronger distal fixation construct. Our favorable results suggest that this technique should be given consideration as a treatment of choice for displaced Weber B fibula fractures.

Bone Plates↗
PubMed1996

Closure of the fibula free flap donor site with the Sure-Closure skin-stretching device.

Fibula osseocutaneous free tissue transfer represents state-of-the-art reconstruction of the oromandibular complex following oncologic resection. The width of the fibula skin paddle is usually limited by the ability to achieve primary wound closure. In some cases the donor site requires skin grafting and subsequent surgical procedures to achieve effective closure, or placement of a tissue expander. The recent development of an indexed tissue advancement system (Sure Closure) makes it possible to take advantage of the viscoelastic properties of skin to close large wound deficits in a single procedure. The system secures and brings together wound edges by applying graduated pressure with a metered force approximator. A series of 12 fibula osseocutaneous free flap defects is presented, which have been successfully closed using this simple, convenient, and safe device.

Bone Transplantation↗
PubMed1991

Combined vascularized fibula and peroneal composite-flap transfer for severe heat-press injury of the forearm.

A free combined vascularized fibula and peroneal composite flap was transferred to the forearm in a patient with a severely damaged forearm following a heat-press injury. The operative technique, postoperative management, and subsequent clinical course are described, and the advantages of this method are outlined. Not only can the fibula now be used as a free vascularized bone graft in simple bone defects, but further applications, such as a combined fibula and peroneal composite flap, can be employed in the treatment of severely damaged forearms.

Burns↗
PubMed1998

Ipsilateral island fibula transfer for segmental tibial defects: antegrade and retrograde fashion.

Five patients with segmental tibial defects whose contralateral fibula could not be used as a donor were treated with ipsilateral island fibular transfer in an antegrade or retrograde fashion. Antegrade-flow pedicled flaps based on the peroneal vessel as in the conventional free flap were used for the proximal or middle one-third tibial defects, whereas retrograde-flow pedicled flaps based on the communicating branch between the peroneal and posterior tibial vessels were used for the middle or distal one-third of the tibia. All patients had one of the following problems: a previously failed free flap, below-knee amputation of the opposite leg because of open tibia fracture, refusal to use the contralateral sound leg, or poor general condition to endure a lengthy operation. Four of the patients also had an associated fibular fracture on the same leg, which was ultimately used as one of the osteotomy sites. The follow-up period was from 31 to 48 months. Time to bony union ranged from 4 to 7 months. Time to full weight bearing was from 5 to 9 months after operation. All of the transferred fibulas showed hypertrophy after weight bearing. Nonunion occurred in two cases, which were treated with a long leg cast and cancellous bone graft, respectively. The limb was shorter by an average of 0.5 cm in three cases, longer by 1.1 cm in one case, and in the last case, it was uncheckable because the opposite limb was previously amputated. Limited arc of rotation was not a problem. Other disabling complications were not seen. We believe that these methods can be a valuable alternative to the contralateral free fibula flap in certain cases.

Adult↗
PubMed1998

Fibula osteoseptocutaneous flap for reconstruction of osteoradionecrosis of the mandible.

Osteoradionecrosis of the mandible poses formidable problems for treatment. In the last 6 years, the fibula osteoseptocutaneous free flap was used in 12 cases to replace mandibles with radionecrotic damage. The presence of a pathologic fracture, exposed necrotic bone, or a persistent fistula not responding to conservative treatment were the indications for such a radical approach. Mandible defects after resection were around 8.0 cm long, and in all cases intraoral mucosa, skin, or both were included with the bone excision. All vascularized fibula osteoseptocutaneous flaps transplanted were successful with good primary bone healing. Adequate facial symmetry and improvement in oral function was achieved. No evidence of osteoradionecrosis recurrence was observed after a mean follow-up period of 3 years and 9 months. The advantages of using the fibula osteoseptocutaneous flap for mandible reconstruction are numerous, and good aesthetic and functional results can be obtained when it is used for reconstruction after radical excision of osteoradionecrotic lesions.

Adult↗
PubMed2000

Soleus-fibula free transfer in lower limb reconstruction.

Free-fibula transfer has been widely used since 1975. Many modifications have been described; one of them, association of the lateral part of the soleus muscle to the fibula, is reported here through a 14-case series. This composite flap is intended for extensive defects of the lower limbs involving bone and soft tissues. The flap is considered by the authors to be reliable, with a constant vascularization. A 20-cm length offibula may be harvested associated either with the lateral part of the soleus muscle or with the whole muscle. Moreover, the soleus muscle represents a vascular security inasmuch as it preserves both medullar and periosteal bone supply. Fourteen cases have been performed by the authors since 1978 and could be reviewed with a minimum 2-year follow-up. Average length of bone defect was 12 cm, and average length offibula harvested was 18.6 cm. Soft-tissue defect was always associated and ranged from 8 x 4 cm to 20 x 30 cm. The fibula was harvested with the lateral part of the soleus muscle in 10 cases and with the whole soleus muscle in 4 cases. One total treatment failure was reported and was related to intimal degenerative lesions on veins used for arteriovenous bypass. In other patients, mean time for bone healing was 11 months. Patients could walk again, on average, 17 months after reconstruction. Sequelae at the donor site were minimal.

Adolescent↗