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PubMed1990

The role of Ender rodding in tibial fractures with an intact fibula.

Thirty-three patients with tibia fractures and intact fibula were studied to determine the efficacy of Ender rod fixation in preventing a varus deformity of the tibia. Twenty-one patients were treated nonoperatively with five (23.8%) developing a significant varus angulation (greater than five degrees). No varus malunions were noted in those patients treated with Ender rods. Those patients treated with Ender rods and early weight-bearing had a shorter average time to union than those treated nonoperatively. We therefore feel that Ender rod fixation is a viable treatment modality in tibia fractures with an intact fibula. In these fractures the use of Ender rods helps prevent significant varus malunion and allows early weight-bearing, thus permitting early mobilization of the traumatized patient.

Adult↗
PubMed1998

Primary insertion of osseointegrated dental implants into fibula osteoseptocutaneous free flap for mandible reconstruction.

Twelve patients with segmental mandibular defects were reconstructed with fibula osteoseptocutaneous flaps and simultaneous placement of osseointegrated implants. Decision to perform this procedure was based on the facts that all patients had benign diseases, did not require postoperative radiotherapy, were in good general and oral conditions, and were psychologically motivated. A total of 34 fixtures was inserted in the first stage. Eight patients underwent second stage surgery, which consisted of connection of the implant abutments to the fixtures and the use of palatal mucosal grafts around the implants. Final dental prostheses were fixed 1 month later in seven patients, at this time. All flaps survived after surgery, and no implant failure was observed after a mean follow-up period of 25 months. Only one fixture was not used during the subsequent stage and was left as a sleeper. Fixed dental prostheses were used in five patients and removable overlay prostheses in the other two. Chewing function was recovered between 4 and 6 weeks after the start using the definitive dental prosthesis. In contrast to previous results, we conclude that excellent results can be achieved when this combined procedure is used in carefully selected patients. In addition, it is confirmed that the fibula osteoseptocutaneous flap is a versatile, reliable composite tissue that facilitates primary placement of osseointegrated dental implants during mandible reconstruction, thus allowing full oral rehabilitation in a shorter period of time.

Adolescent↗
PubMed2003

Ankle-arm index versus angiography for the preassessment of the fibula free flap.

Peripheral arterial occlusive disease or congenital anomalies of the major crural arteries may limit the use of the fibula free flap and should be detected preoperatively. Conventional selective angiography is the definitive standard imaging method for making this diagnosis, but it has drawbacks. A safer, cheaper, more accurate, and noninvasive alternative is desirable. The authors sought to test the hypothesis that the ankle-arm index of each of the three crural arteries, combined with pencil Doppler examination of the peroneal skin perforators, would provide adequate information to restrict the use of angiography to cases in which the outcomes of either or both of these options are insufficient. The ankle-arm index data of each of the three crural arteries, as well as pencil Doppler examination of the peroneal skin perforators of both legs of nine prospectively included patients and the nonoperated legs of 13 retrospectively included patients, were compared statistically in four different ways with the preoperative angiographic findings. A combined ankle-arm index and pencil Doppler examination is not accurate enough to detect legs or arteries with subclinical peripheral arterial occlusive disease or vascular variation and, hence, is not a sufficient basis on which to develop the surgical plan for a fibula free flap.

Adult↗
PubMed2004

The versatility of the free osteocutaneous fibula flap in the reconstruction of extremities after sarcoma resection.

BACKGROUND: An understanding of the biology of bone and soft-tissue sarcomas, knowledge of adjuvant therapies and refinement in techniques of reconstructive surgery have allowed limb-sparing and limb salvage surgery to become a reality in the management of malignant tumors of the extremities. Functional limb salvage following radical resection has become a possibility in many resectable tumors by the use of alloplastic prostheses, homograft or autogenous bone for skeletal reconstitution combined with vascularized soft tissue coverage. Although the free fibula flap has been well described for reconstructions of the mandible and oral cavity, it has not been widely presented as an ideal tool to preserve extremities and to circumvent amputation. PATIENTS AND METHODS: We describe the complex surgical reconstruction in four patients with primary sarcomas of the extremities. The sarcomas (Ewing's sarcoma, osteosarcoma and epitheloid sarcoma) were resected radically and the massive bone and soft tissue defect was replaced by vascularized free fibula transfer. RESULTS: We present our experience with versatility of this osteocutaneous flap to allow reconstruction and salvage of extremitity sarcomas. There were no operative or postoperative complication and all the four patients had good limb function. The flap was found to be versatile as it could be used for either upper limb or lower limb and for large defects. The results were better in upper limb than in lower limb. CONCLUSIONS: Free fibular graft was found to be effective for salvaging limb function where a massive bone defect resulted from wide tumor resection in the extremities.

Journal Article↗
PubMed1979

[The isolated loss of extension of the great toe following osteotomy of the fibula (author's transl)].

A peroneal nerve palsy can be observed following operative procedures or traumatic lesions of the lower leg. Primary damage of the nerve must be differentiated from the tibialis-anterior syndrome and the pseudo-paralysis. Following corrective osteotomies of the tibia with dissection of the fibula in the upper or medial third isolated lesions of the extensor hallucis longus muscle can be seen. Electromyographic and anatomical studies reveal that they may be caused by an isolated damage of the motor nerve fibres connecting the deep branch of the peroneal nerve with the extensor hallucis longus muscle lying very close to the fibula. Suggestions how to avoid this damage are made in the paper.

Electromyography↗
PubMed1994

The neurocutaneous free fibula flap in mandibular reconstruction.

Despite the delayed application of the free fibula flap to mandibular reconstruction, its recognition as a reliable, sensate skin paddle combined with enough bone to repair any mandibular defect and offer bicortical fixation of osseointegrated implants has proved the free fibula flap to be a "workhorse" in the repair of composite mandibular defects. The low donor site morbidity slightly eases the wait for the molecular reconstructive "cocktails" from the shelf of the next millennium.

Adult↗
PubMed1996

Giant cell tumor of the proximal fibula: surgical management.

Five patients with giant cell tumor of the proximal fibula were treated with intralesional excision of the lesion, preservation of the peroneal nerve, and reconstruction of the lateral collateral ligament. At minimum 24-month follow-up there have been no local recurrences. Four patients exhibit normal function of the peroneal nerve and one has grade 4 strength of the muscles innervated by this nerve. No patient demonstrated varus instability. Marginal excision with nerve preservation and reconstruction of the ligament is a worthwhile procedure for treatment of this relatively uncommon lesion.

Adult↗
PubMed1998

Reconstruction of mandible with fibula free flap.

The fibula can be used as a donor for a free flap for mandible reconstruction. It has the advantages of low donor site morbidity, consistent shape, ample length, and distant location to enable a two-team approach, allowing multiple osteotomies because of its periosteal circulation. It can be raised with a skin island for composite tissue reconstruction. Eight segmental mandibular defects (average 11.62 cm) were reconstructed following resection for tumour. Six defects consisted of bone alone and the other two had only a small amount of associated intraoral soft-tissue loss. Two patients underwent primary reconstruction. We performed two or three osteotomies on each graft and used miniplates and wires for bone fixation. The flaps survived in all patients. All osteotomy sites healed primarily. The aesthetic result of reconstruction was satisfactory.

Adult↗
PubMed2000

New mesomelic dysplasia with absent fibulae and triangular tibiae.

We report on two unrelated, sporadic cases of a mesomelic dysplasia characterized by absence of fibulae and severely hypoplastic, triangular-shaped tibiae. Moderate mesomelic shortness was present in the upper limbs with proximal widening of the ulnae. There was also axial skeletal involvement in both cases, characterized radiographically by an abnormal pelvis and marked bilateral glenoid hypoplasia. These cases appear to represent a new form of mesomelic dysplasia distinct from those previously delineated.

Bone Diseases, Developmental↗
PubMed1988

Absence of fibula and ulna with oligodactyly, contractures, right-angle bowing of femora, abnormal facial morphology, cleft lip/palate and brain malformation in two sibs: a possibly new lethal syndrome.

Absence of fibulae, and unilateral absence of ulna, associated with lateral oligodactyly, and rectangular bowing of the femora are the prominent features of a lethal syndrome studied in two children of related parents. Other malformations are cleft lip and palate and posterior midline abnormalities of the brain. One similar though not identical MCA-syndrome was reported. The literature is reviewed with respect to ulno-fibular malformations.

Abnormalities, Multiple↗
PubMed1991

Fuhrmann syndrome of right-angle bowed femora, absence of fibulae and digital anomalies: two further cases.

We describe 2 patients with bilateral right-angle bowing of femora, absence of fibulae, and reduced, flattened and nail-less toes and symmetrical fingernail deficiency in a consanguineous family of ethnic South Vietnamese Baptists and a non-consanguineous Polish family. These cases are similar to those reported by Fuhrmann et al. (in "Skeletal Dysplasias," New York: Alan R. Liss, Inc., pp 519-524), indicating possible autosomal recessive inheritance of this rare non-lethal limb malformation syndrome.

Abnormalities, Multiple↗
PubMed1985

Fracture healing in the rabbit fibula when subjected to various capacitively coupled electrical fields.

The effect of capacitively coupled electrical stimulation on the healing of midshaft transverse osteotomies of the rabbit fibula is assessed roentgenographically, mechanically, and histologically. The results show that a dose-response curve for capacitive coupling and fracture healing exists and that a 220 mV, 250 microA, 60 kHz applied electrical signal (0.33 V/cm internal electric field) is the most effective signal for fracture stimulation in this model.

Animals↗
PubMed2003

Nutritive perfusion at donor site after microvascular fibula transfer.

There are many reports on the versatility of the fibular flap, but only a few studies have reported on the morbidity, and none on the nutritive perfusion, of the donor site. This study describes for the first time the quantitative investigation of nutritive perfusion at the donor site after osteomyo-cutaneous fibula transfer. Tissue nutrition of the lower leg was measured in 25 patients by micro-lightguide spectrophotometry and laser Doppler flowmetry. In a standardized examination, hemoglobin oxygenation and blood flow of the donor leg and the contralateral leg (intraindividual control) were measured at the nutritive region of the peroneal artery (I), posterior tibial artery (II), and anterior tibial artery (III). In the operated leg, blood flow was significantly reduced in region I with the sacrificed peroneal artery, and significantly increased in region II and III, probably for compensation (P = 0.03). Decreased hemoglobin oxygenation and blood flow of the peroneal region at the donor site were without significance in comparison to the control leg (P = 0.55 and P = 0.35, respectively). Decreased nutritive perfusion at the donor site was below the threshold of clinical manifestation, and supports the low donor site morbidity following fibular grafting.

Female↗
PubMed1984

A vascularized fibula model to study vascularized canine bone grafts.

We have refined the experimental canine vascularized fibula model in 26 dog experiments. Our results have demonstrated that both periosteal and endosteal blood flow are retained following end-to-end anastomosis of the bone graft pedicle artery and vein. The success of this model depends on detailed knowledge of the surgical anatomy and upon meticulous microvascular surgical technique.

Animals↗
PubMed1987

Laser Doppler bone probe in vascularized fibula transfers: a preliminary report.

Continuous monitoring of circulation in bone transfers without a skin element may be possible with a laser doppler bone probe consistent with any free tissue transfer. Immediate reintervention is necessary when vascular insufficiency is suspected. In two clinical cases of vascularized fibula transfer, we were able to compare skin probe recordings with intraosseous probe recordings. There was no apparent difference in the recordings, suggesting that the bone probe alone may be useful for monitoring bone transfers and that it warrants further study.

Adolescent↗
PubMed1993

Mandibular reconstruction: experience with the free vascularized fibula transfer.

Mandibular resection, following surgery for tumor or osteoradionecrosis, leaves a patient with a swallowing, speech, and cosmetic disability. Repair of the oromandibular defect is difficult and various prostheses and grafts have been used and reported. The most popular form of mandibular reconstruction is the use of the free, vascularized bone transfer. We report our experience with the free vascularized fibula bone transfer in eight patients.

Aged↗