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PubMedDate not supplied

Ankle stability after resection of the distal third of the fibula for giant-cell lesions: report of two cases.

Giant-cell tumors and aneurysmal bone cysts involving the lower end of fibula pose special management problems. Excision of the lower end of the fibula in such cases is undertaken reluctantly because it may result in lateral instability of the ankle. Two cases, one of giant-cell tumor and one of aneurysmal bone cyst of the lower end of the fibula, were excised and the lateral ligaments of the ankle and the periarticular tissue were carefully repaired. In both patients the ankle joints were stable two years after the operation.

Adult↗
PubMed1994

[Experience in the management of osteomyelitis of the fibula].

Authors report on experiences gained with the treatment of 22 cases of osteomyelitis of the fibula in the 17 years material of their Department. It is stated that the fibula osteomyelitis has to be treated first of all with operation and the end results of the treatment are good. In this, the anatomical situation which enables the resection and removal of the proximal part of this bone without more ado has a role. The more frequent occurrence of the disease on the right fibula in their material is an accidental finding.

Adolescent↗
PubMed1993

[Bone regeneration in the distal third of the fibula after resection of an aneurysmal bone cyst using an original technique].

Resection of the distal-third of the fibula for tumor may improve important static troubles of the ankle. The authors report an original technique which permits to benefit to osteogenic ability of periosteum to produce new bone in children and teenagers. This technique avoids to take out autograft and permits a complete regeneration of the fibula, using a "lift" procedure. It can be also used when a large bone graft has to be taken in the medial-third of the fibula and when the periosteum is separable enough to be completely preserved.

Adolescent↗
PubMed1993

[Free, vascularized, folded fibula transplantation].

A free vascularized folded fibula as possibility for reconstruction of segmental bony defects up to 9 cm is described. Preserving its vascularisation, the fibula is osteotomized and folded into two equal or two vascularized bone transplants of different length with only one arterial and venous pedicle. Folding of the fibula leads to a biomechanically superior stabilisation. This technique was used in a posttraumatic osteomyelitic defect of the tibia after a Pilon tibiale fracture.

Adult↗
PubMed1996

[The folded fibula flap: anatomical study and clinical application to septic post-traumatic femoral reconstruction. A propos of 6 cases].

The reconstruction of extensive femoral defects, particularly septic, by revascularized free fibula flap has become part of routine practice for many years. Following the demonstration of secondary stress fractures, splitting of the fibula into two vascularized barrels was proposed in 1987 to avoid this complication. The authors conducted an anatomical study on 100 dry bones in order to define the situation of the fibular foramen which is usually found at about 1.45 cm from the midpoint of the fibula. This foramen must be spared during the intermediate splitting osteotomy in order to obtain two bone barrels: one with a double centromedullary and periosteal blood supply which will be used like a contromedullary pin, and the other with only a periosteal blood supply, which will be used as a medial or lateral splint. The deductions concerning the preoperative strategy and splitting technique are explained as a function of the length of the defect. From 1989 to 1993, 6 male patients underwent extensive femoral reconstruction (average length of 9.8 cm). Four free revascularized transfers were performed, including one osteocutaneous flap. In two cases, the osteocutaneous transfer was a proximally based island pedicle flap. Apart from one patient who was subsequently amputated, five patients underwent a secondary autologous bone graft after an average of three months. Consolidation was achieved after a mean of 12.6 months. A secondary stress fracture was observed in one case. With a minimum follow-up of two years, all patients are able to walk with a mean shortening of 2 cm of the reconstructed limb and without any donor site sequelae.

Adult↗
PubMed1977

Hypoplasia of the fibula.

Fibular hypoplasia occurs in differing degrees of severity with fibular hemimelia as its most severe form. Normally the distal epiphyseal plate of the fibula is at the same level as the distal end of the distal tibial epiphysis, whereas the tip of the proximal fibular epiphysis is level with the proximal tibial epiphyseal plate. Varying degrees of shortening of the fibula in relation to the tibia were found in 14 children, 6 of them boys. Shortening at the distal end of the tibia leads to instability of the ankle. Shortening at the proximal end of the fibula leads to hypoplasia of the lateral tibial plateau and valgus deformity of the knee. Syme type ankle disarticulation became necessary in five cases of fibular hemimelia because of leg length discrepancies or ankle instability.

Ankle Joint↗
PubMed1997

Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head.

Sixty-five patients (88 hips) who received free vascularized fibula grafting for treatment of osteonecrosis of the femoral head at the University of Pittsburgh Medical Center, were followed for at least 3 years (average followup, 5.5 years; range, 3-7 years). There were 46 men and 19 women with an average age of 37 years (range, 20-52 years). All patients were evaluated using history, physical examination, Harris Hip Score, anteroposterior and lateral radiographs, and magnetic resonance images. The classification system of Steinberg et al (1995) was used to stage the disease. At final evaluation, 31 hips (35.2%) were rated excellent (Harris Hip Score > 90 points, minimal or no pain), 30 hips (34.1%) were rated good (Harris Hip Score 80-89 points, slight pain), seven hips (8%) were rated fair (Harris Hip Score 70-79, slight or moderate pain), and 20 hips (22.7%) were rated poor (Harris Hip Score < 70, pain). Twenty hips in 17 patients required total hip arthroplasty. In the remaining hips, the disease apparently arrested and the contour of the femoral head was preserved. Kaplan-Meier survivorship analyses showed that the probability of conversion to total hip arthroplasty within an average of 5.5 years after free vascularized fibula grafting was 28% for Stage II hips and 38% for Stages III and IV hips. The hip survival rate for subgroups at 5.5 years was 100% for Stages IC and IIA, 94% for Stage IIB, 50% for Stage IIC, 80% for Stage IIIB, 58% for Stage IIIC, 72% for Stage IVA, and 58% for Stage IVB. Free vascularized fibula grafting is a reliable operation and can preserve hip function and diminish pain successfully.

Adult↗
PubMed1998

Sensate osteocutaneous fibula flap: anatomic study of the innervation pattern of the skin flap.

BACKGROUND: For oromandibular reconstructions, an osteocutaneous fibula flap provides sufficient bone and pliable skin. Sensory reinnervation could possibly prevent problems in mastication and deglutition. METHODS: In this anatomic study, 33 cadaver limbs were microsurgical dissected. We investigated the lateral sural cutaneous nerve (LSCN), which supplies sensation to the skin of the lateral lower leg, in relation to the fibula skin flap. The fibula is vascularized by the peroneal vessels via the posterior intermuscular septum. Therefore, the posterior septum determines the center line of the flap design. RESULTS: The LSCN runs in 74% of the dissections posterior to the posterior septum, whereas an anterior branch was seen in 26%. In 54% of the dissections, the distance to the posterior septum was within 3 cm from the septum, whereas in 86%, the distance was found to be within 4 cm. CONCLUSION: The skin flap should be designed more posteriorly to achieve maximal reinnervation.

Cadaver↗
PubMed2003

Fracture of the distal end of the fibula through a persistent physis in an adult with fracture of the medial malleolus.

A 26-year-old woman was injured in a motor vehicle accident and sustained a bimalleolar fracture of the right ankle. Radiographs revealed a shearing fracture of the medial malleolus and a gap in the distal end of the right fibula that resembled epiphysiolysis in children. Fracture of the distal end of the fibula through a persistent physis was suspected. Histological examination of material obtained from the fracture site during surgery revealed remnants of hyaline cartilage. We believe that the fracture occurred at a persistent physis of the distal end of the fibula.

Adult↗
PubMed2005

[Simultaneous noninvasive monitoring for radial forearm and fibula flaps using laser Doppler flowmetry and tissue spectrophotometry].

AIM: In the literature currently available monitoring devices are usually divided into two major groups: those for monitoring perfusion and those for measuring tissue oxygenation. The O(2)C (oxygen to see) system combines these two ways of monitoring free flap viability. The aim of this prospective study was to determine the necessity of flap revision and when unnecessary revision can be avoided. Another point of interest was the question of whether critical values for the successful course of free flaps could be defined and in addition whether such values would differ for different flap types. PATIENTS AND METHODS: In a prospective study 82 free flaps (61 radial forearm flaps and 21 fibula flaps) were monitored with the O(2)C monitoring unit. Measurements were carried out intraoperatively and postoperatively up to 14 days. RESULTS: Perfusion compromise occurred in 12 (14.6%) of 82 monitored free flaps. Operative exploration was performed in seven cases, in five of them successfully. Five flaps (three radial forearm and two fibula flaps) were lost due to vascular compromise, which led to an overall success rate of 93.4%. Venous congestion was identified by a rapid increase in hemoglobin concentration of more than 30%. An abrupt decline of blood flow and hemoglobin oxygenation indicated arterial occlusion. Vascular complications were detected in all cases prior to clinical assessment with no false positive or negative results. For radial forearm flaps a hemoglobin oxygenation of 15%, a superficial flow of 10 AU, and a deep flow of 20 AU were identified as minimum values for flap viability. For fibula flaps a hemoglobin oxygenation of 10%, a superficial flow of 5 AU, and a deep flow of 15 AU were determined as minimum values. CONCLUSION: O(2)C combines laser Doppler flowmetry and tissue spectrophotometry and for the first time allows simultaneous measurement of the microcirculatory parameters including blood flow, flow velocity, hemoglobin concentration, and hemoglobin oxygenation. We found this new noninvasive technique to be a reliable and accurate method for evaluating flap viability and improving the success rate in free flap transfer.

Adolescent↗
PubMed2001

Mandibular reconstruction using a vascularised fibula osteocutaneous flap in a patient with pyknodysostosis.

We present the first successful report of mandibular reconstruction using a free fibula osteocutaneous flap in a patient with pyknodysostosis. The patient had recurrent refractory osteomyelitis of the mandible, which was initially treated with resection and reconstruction using an AO plate. Recurrent fistula formation with loosening of the plate was treated by radical re-excision and reconstruction with a free fibula flap. The postoperative course was uneventful; at 14 months the bony union was almost complete, without resorption or atrophy of the grafted fibula on radiography.

Adult↗
PubMed1999

Routine donor leg angiography before vascularized free fibula transplantation is not necessary: a prospective study in 120 clinical cases.

To evaluate the value of routine preoperative angiographies of donor sites, 120 patients with free fibula osteoseptocutaneous flap transplantations were included in this prospective study, which consisted of preoperative evaluation of dorsalis pedis and tibial posterior artery pulsation and angiographies of the donor legs (120 patients) and contralateral legs (111 patients). Both pedal pulses were palpable in 114 patients, and only one pulse was palpable in six patients. The respective nonpalpable foot pulses were detectable with pencil Doppler in five patients, but they were not detectable in one patient. Intraoperatively, the latter patient had a relatively hypertrophied peroneal artery as compared with both the tibial posterior and tibial anterior arteries. The angiographic result was arteria peronea magna. The other five patients showed intraoperatively and angiographically normal-sized major arteries of the lower leg. In three patients with normal pedal pulses, hypoplasias of either the tibial anterior or tibial posterior arteries were found intraoperatively. These findings corresponded with the angiographical results. In all patients (n = 119), except one with peroneal artery hemangioma, free osteoseptocutaneous fibula flap was harvested from the originally planned leg without subsequent sequelae to the respective donor leg. In 231 leg angiographies, only 7 cases (3 percent) with abnormalsized major lower leg arteries were described. The diagnoses in these cases were hypoplasia of either the tibial posterior or tibial anterior artery (4 cases), arteria peronea magna (2 cases, one of which was a false positive), absence of peroneal artery combined with hypoplastic tibial posterior artery (1 case), and hemangioma of the peroneal artery (1 case). From this prospective study, it was determined that routine preoperative angiography of the donor leg before fibula transplantation is not justified. It does not add relevant new information about donor leg vascularity, provided that the clinical evaluation of the pedal pulses is well conducted. The only two conditions that may require a preoperative donor leg angiography are abnormal pedal pulses or significant previous lower leg trauma.

Adolescent↗
PubMed2004

Maxillary reconstruction with a fibula osteoseptocutaneous free flap and simultaneous insertion of osseointegrated dental implants.

The fibula osteoseptocutaneous flap is a good option for reconstruction of three-dimensional composite maxillary defects. This flap provides both bone and soft-tissue reconstruction and allows osseointegrated dental implantation, either simultaneously or in a second-stage procedure. Simultaneous placement of osseointegrated dental implants reduces operative sessions and allows faster oral rehabilitation for properly selected patients. The defects may result from trauma or resection of benign tumors or low-grade malignancies. Between August of 1999 and July of 2001, three patients underwent maxillary reconstruction with the fibula osteoseptocutaneous flap and simultaneous osseointegrated dental implants. The cause of the defect was trauma in two cases and resection of an adenoid cystic carcinoma in the other. The mean length of the fibula used for bony reconstruction was 4.7 cm. One osteotomy was performed in one case and no osteotomy was necessary in the other two. Skin islands of 8 x 2.5 cm and 16 x 3.5 cm were used for two patients. For the other patient, a double skin island was used for both nasal (6 x 4 cm) and oral (6 x 5 cm) reconstructions. Two osseointegrated implants were inserted into the fibular bone for each patient. Six months after the first-stage procedure, palatal rotation flaps or mucosa grafts were used to cover the exposed implant necks and prepare the implants for prostheses. One month after the second-stage procedure, prostheses were placed. An implant-supported prosthesis was used for one patient and implant/tissue-supported prostheses were used for the others. At a mean follow-up time of 30 months (range, 16 to 38 months), all patients were able to use the dental prosthesis for chewing (beginning 6 weeks after the final procedure) and all patients were satisfied with the cosmetic results.

Adult↗
PubMed1998

Closed tibia fracture. "The effect of an intact fibula and the location of tibia fracture on fracture union".

Tibial fractures are common and complications occur more frequently than any other long bone fractures. The effect of fibula and location of fracture on union of Tibia fracture remain controversial. A retrospective study of unilateral closed tibial shaft fractures without any associated injury was done. From 1988 to 1992, 74 out of 103 patients were available for the study. There were 60 males and 14 females with the age ranges from 3 to 75 years with an average of 29.7 years. The differences of fractures healing were analyses with respect to the status of the fibula and the location of the tibial fracture. This study concludes that the location of the fracture and the status of the fibula have no significant influence on healing (p > 0.05).

Adolescent↗
PubMed2001

Bilateral fracture of the tibial shaft with intact fibulae.

We report the case history, treatment, and follow-up of a 16-year-old girl who sustained symmetrical fractures of the right and left tibia without fractures of the fibulae. Although a fracture of the tibia with an intact fibula is not an uncommon fracture pattern, a bilateral fracture of this type is quite rare, and we have been unable to find such a reported case in our review of the literature. The management of a fracture of the tibia with an intact fibula is controversial, with potential complications of delayed union and varus malunion. For this reason, as well as the bilateral nature of the injury, we felt operative treatment to be indicated.

Adolescent↗
PubMedDate not supplied

Reconstruction of massive femur defect with free vascularized fibula graft following tumor resection.

BACKGROUND: The reconstruction of femur defects following tumor resection remains a surgical challenge. The clinical outcome of free vascularized fibula graft (FVFG) reconstruction for massive femur defects of more than 10 cm that were secondary to skeletal tumor resection is reported. PATIENTS AND METHODS: Six patients with a mean of 3.3 years follow-up were reviewed. Five patients received double or folded vascularized fibula grafts and 1 received a single graft. The mean bony defect of the femur was 13 cm and the mean length of grafted fibula was 15 cm. RESULTS: Five patients were free of disease at final follow-up; 10 out of 11 (91%) FVFGSs were transferred successfully. Five patients had a successful outcome with bony union. No stress fractures had occurred up until the final follow-up. All patients except one could walk without a brace after a mean of 9 months post-operatively. CONCLUSION: Double or folded FVFG is a reliable reconstructive procedure for massive femur defects.

Adolescent↗
PubMed1976

[Supporting role of the fibula in tibial fractures].

The possibilities of the supporting effect of the fibula and of its preclusion are discussed. The indication of the fibulotomia is dealt with. According to the authors' standpoint in the case of the anatomical reposition of the tibial fracture and after its staple synthesis the supporting effect of the fibula is not be be feared. In these cases the reposition and the osteosynthesis of the fibula neutralize fairly well also the motive forces acting on the tibial fracture.

Bone Nails↗
PubMed2002

Midface reconstruction with the fibula free flap.

OBJECTIVE: To evaluate the use, indications, and outcomes of the fibula osteocutaneous free flap when reconstructing the midface. DESIGN: Retrospective review of a case series. SETTING: Tertiary referral center. PATIENTS: We evaluated all patients requiring midface reconstruction after tumor resection between January 1, 1994, and January 1, 2000. Twenty-seven individuals who lacked sufficient retentive surfaces and/or teeth to support a conventional prosthesis were offered vascularized bony reconstruction. INTERVENTIONS: All patients underwent fibular osteocutaneous free flap reconstruction of the midface: 16 primarily, 11 secondarily. MAIN OUTCOME MEASURES: Success of free tissue transfer, perioperative complications, oral diet, speech, type of dental reconstruction, and cosmesis. RESULTS: Twenty-six of 27 flaps survived. Four patients had wound complications managed successfully with local wound care. Fourteen patients achieved a regular diet and 13 patients maintain a soft diet. Eighteen patients had osseointegrated implants placed, and 14 patients used an implant-borne prosthesis. Cosmetic results were judged to be excellent in 14 patients; good in 8; fair in 4; and poor in 1. CONCLUSIONS: Use of the fibula osteocutaneous free flap to reconstruct the midface is highly reliable and our flap of choice for lower maxillary defects requiring bony reconstruction. However, when orbitozygomatic support is the primary objective, the utility of this flap is limited. Because of the complexity of this procedure, the choice of midface reconstruction technique should be individualized for each patient.

Adolescent↗