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At least 451 records · Page 25Linked to original sources
PubMed1992

Osseointegrated implants and functional prosthetic rehabilitation in microvascular fibula free flap reconstructed mandibles.

The mandibulectomy deformity can be alleviated by immediate mandibular reconstruction using the microvascular fibula free flap. Before the advent of microvascular reconstruction, conventional and maxillofacial prosthetic rehabilitation offered limited success after surgery due to the failure to reestablish the bony foundation and soft tissues (tongue, floor of mouth, vestibule) anatomically and physiologically. With proper multidisciplinary pretreatment planning and postoperative treatment, osseointegrated implants can be strategically placed in patients with these reconstructed mandibles to restore occlusal and masticatory function. The records of seven patients who underwent reconstructive surgery and osseointegrated implants were reviewed, with an emphasis on the variety of prosthetic designs and principles used to maximize long-term efficiency and preservation of tissues.

Adolescent↗
PubMed1996

Combined radius and ulna reconstruction with a free fibula transfer.

A 20-year-old man sustained a high energy injury to his right forearm resulting in comminuted open fractures of the forearm with 6 cm bone loss of the radius and 7 cm bone loss of the ulna. A bone segment was removed from the middle of a free fibula transfer to produce a single flap with two vascularised bone segments to reconstruct both the radius and ulna defects. Step osteotomies were stabilised with a single lag screw for each fracture line and, with a rigid external fixation device on the ulna, two vein grafts were used to anastomose the flap pedicle to the recipient vessels in the forearm. The postoperative period was uneventful. X-rays and scintigrams confirmed good healing of the fractures and normal perfusion of the flap so that the external fixation device could be removed 3 months after surgery. One year after the injury, the patient underwent a functional evaluation showing excellent results with very good preservation of rotation of the forearm.

Adult↗
PubMed2004

Outcome after surgery for Maisonneuve fracture of the fibula.

The aim of this study was to assess outcome in patients treated surgically for Maisonneuve fractures and to highlight factors associated with a suboptimal result. The authors present a review of 14 patients with Maisonneuve fractures. The mean age was 35.5 years. The most common injury mechanism was a twist incurred whilst participating in sport. The goal of treatment was the anatomic restoration of the ankle mortice with accurate renewal of fibular length. All patients had one or two suprasyndesmotic screws inserted percutaneously under fluoroscopic guidance. These were successfully removed under local anaesthesia in 13 cases (93%). Patients were reassessed clinically and evaluated both functionally and radiographically. Average follow-up was 25.3 months. Twelve patients (86%) had a satisfactory result. They returned to previous activity levels and had favourable Global Foot and Ankle (mean: 95.57) and Shoe Comfort (mean: 81.66) Raw Scores. Ankle range of motion and radiographs were normal. Two patients had an unsatisfactory result. Surgical intervention is recommended to maintain reduction of the fibula into the notch on the tibia, as shortening results in mandatory lateral talar displacement, predisposing to painful ankle arthrosis. The severity of the initial injury and co-morbid disease may adversely affect outcome.

Adult↗
PubMed2002

Defect-related variations in mandibular reconstruction using fibula grafts. A review of 96 cases.

Despite the popularity of the donor region 'laterodorsal calf' with the fibula, the flexor muscles and the overlying skin for microsurgical bone and soft tissue transfer some limitations and possible pitfalls have to be considered. We report on 93 patients who had 96 reconstructions, 65 with and 31 without soft tissue transfer in 8 years using microvascular fibular grafts for mandibular replacement and oromandibular reconstruction. Six patients died within 4 weeks and eight flaps were lost. Necrosis of the skin paddle occurred in 7 (11%) of 61 cases with uncomplicated bony healing.

Adolescent↗
PubMedDate not supplied

Intraosseous lipoma of the fibula.

Intraosseous lipoma is a rare benign primary tumor of the bone. It has a wide distribution and may occur in the appendicular as well as the axial skeleton. The metaphysis of the long bones is the most frequently affected region. We report a case of intraosseous lipoma of the fibula with radiographic, gross, and microscopic features.

Adult↗
PubMed1994

Mandibular reconstruction with the free fibula osteocutaneous flap.

Experience with 17 mandibular reconstructions by the free fibula flap is presented. The main advantages of this reconstruction method include the bicortical structure of the bone and its adaptability to conform to the mandibular contour. The only real disadvantage is the limited height of the bone graft, which does not allow alveolar ridge reconstruction. An implant-borne dental prosthesis can, however, generally be made for functional occlusal rehabilitation.

Adult↗
PubMed2002

Vertical distraction osteogenesis of fibula transplants for mandibular reconstruction--a preliminary study.

INTRODUCTION: When reconstructing the mandible after tumour resection with a fibular graft, the mandible is often vertically deficient, making placement of dental implants impossible. PATIENTS: Segmental vertical distraction of the reconstructed mandible was performed in nine patients following tumour surgery between February 1998 and 2001. Their age was 14-65 years (average 46.3); all underwent radiotherapy with a dose of up to 55.6 Gy prior to tumour resection. Mandibular discontinuity was repaired with a microvascular fibular bone graft. All grafts had a vertical bone deficit ranging from 9 to 12 mm when compared with the non-resected part of the mandibles. METHODS: All patients underwent segmental vertical distraction of the transplants. The distraction devices were applied intraorally. Distraction of 1.0 mm/day was performed using a Martin distractor (TRACK 1.5) followed by 12 weeks retention time. RESULTS: The increase of vertical bone height was stable and enabled placement of dental implants without any complications. CONCLUSION: Vertical distraction osteogenesis may become a common procedure in the treatment of alveolar ridge deficiency resulting from transplanting fibulae for mandibular reconstruction following tumour surgery.

Adolescent↗
PubMed2003

Fibula microvascular free tissue reconstruction of the severely comminuted atrophic mandible fracture--case report.

Severely atrophic comminuted fractures of the mandible often have inadequate bone stock available to allow for adequate rigid fixation and subsequent progression to union. Grafting with rib, iliac crest or a variety of allograft materials is required in order to increase the success rate of the repair in this patient population. In this article, we report our favourable experience in using a fibula microvascular free tissue transfer for the treatment of a particularly challenging patient with a fractured atrophic mandible. Secondary implant rehabilitation completed the reconstruction. This method may represent an alternative in the treatment of fractures of the severely atrophic mandible in select individuals.

Aged↗
PubMed1998

Distraction osteogenesis of a fibula free flap used for mandibular reconstruction: preliminary report.

The authors report the first case of mandibular distraction osteogenesis applied to a fibula microvascularized flap used to reconstruct an almost entire mandible. The technique and complications are described. The literature is reviewed. The biological and physiological process of bone elongation by Ilizarov's method is explained according new studies on chondroid tissue. Preoperative planning of vectors of device placement and trajectory is essential for good results.

Female↗
PubMed1999

Local administration of activin promotes fracture healing in the rat fibula fracture model.

Osteogenic activities of activin, a member of the transforming growth factor (TGF)-beta superfamily, have been demonstrated in both in vitro and in vivo studies. The present study investigates the effects of topical application of activin on fracture healing using rat fibula fracture models. Activin (0.4-10 microg/day) was injected locally to the fracture once a day for 2 weeks. Activin promoted callus formation in a dose-dependent manner and both callus volume and callus weight were significantly increased with doses of 2-10 microg/day activin. Also, 3 weeks of activin treatment increased the mechanical strength of the healing bone in addition to the callus mass. Histological study 2 weeks after the fracture revealed that activin promoted endochondral bone formation. Immunohistochemical examination of the fractured tibia revealed that activin was localized to osteoblasts and chondrocytes in the region ossified both endochondrally and intramembranously. These findings suggest that activin expressed during fracture healing promotes the healing process through an autocrine/paracrine mode of action.

Activins↗
PubMedDate not supplied

Fixation of osteoporotic distal fibula fractures: A biomechanical comparison of locking versus conventional plates.

The increased use of locking plates to treat difficult fracture scenarios has been advocated in patients that have reduced bone mineral density. One of these difficult fracture patterns, fixation of the distal fragment of a distal fibula fracture, may depend on unicortical and cancellous bony purchase. This study investigated the construct stiffness afforded by using locking and conventional plating schema in a cadaveric model. Overall, the data indicate that a locking plate construct with two distal unicortical screws was mechanically equivalent to standard plating with 3 distal screws. In addition, fixation with the standard plates was dependent on bone mineral density (BMD) whereas the locking plate fixation was independent of BMD. The clinical implication of this study is that locking plates may be advantageous in patients with the most severe osteoporosis.

Aged↗
PubMed2002

Ipsilateral free fibula transfer for reconstruction of a segmental femoral-shaft defect.

We describe an ipsilateral free fibula transfer for segmental femur reconstruction with venous interpositional grafts. Preparation and use of vessels at the recipient site for microvascular anastomosis is avoided. This represents a valuable modification of previously reported techniques, and should be considered as an alternative to conventional techniques, which regularly require more dissection at the reconstructive site.

Adult↗
PubMed2002

Functional outcome following excision of tumours of the distal radius and reconstruction by autologous non-vascularized osteoarticular fibula grafting.

The distal radius and its articulations clearly have a vital role in the functional abilities of the hand and wrist. The treatment of tumours of the radius, therefore, needs to achieve satisfactory clearance of the lesions while also preserving as much wrist function as possible. We have employed osteoarticular autologous fibula grafts to reconstitute the distal radius after tumour excision. Since 1992, 13 patients have been treated by this technique for tumours of the distal radius. The group comprised patients with primary and recurrent giant cell tumours of bone, osteosarcoma, chondrosarcoma and Ewing's tumour. This technique achieves a satisfactory functional result without compromise of the prognosis for the tumour.

Adult↗
PubMed2000

Free fibula donor-site morbidity: the Mayo experience with 100 consecutive harvests.

A retrospective analysis of 100 consecutive patients undergoing free fibula harvest at the Mayo Clinic is presented. Every patient was analyzed by reviewing postoperative physical examination data. All patients were evaluated and followed in the early postoperative course by the physical medicine and rehabilitation services. Patients were followed from 3 to 60 months, with an average follow up of 17.42 months. In the patient group, 72 flaps were osseous and 28 osteocutaneous. Thirty-six complications at the donor site were observed in 30 patients. An additional 19 patients required prolonged pharmacologic pain control beyond the first 6 postoperative weeks, with no donor-site complications clinically detectable. Hammertoe was observed in six patients and wound dehiscence in seven patients. Tendon exposure was observed in five patients; partial split-thickness skin graft loss was observed in eight. Numbness of the foot was reported in 10 patients. Fifteen patient had limited maximum ambulatory distance to less than 1000 m. An additional six patients reported difficulty walking stairs. Attention to details and meticulous wound care are required to further reduce wound-healing complications. Immediate postoperative involvement of the physical medicine and rehabilitation services was beneficial in early patient mobilization and achievement of preoperative ambulation levels. After a short rehabilitation period, the majority of patients were able to engage in all daily activities.

Adult↗
PubMed2002

Free fibula flap-donor-site morbidity: case report and review of the literature.

The free osteocutaneous fibula flap is the most commonly transferred vascularized bone flap used today. The associated donor site morbidity is well-reported, including vague pain which usually presents late, and is associated with few objective clinical findings. The authors report a case in which the pain had an identifiable cause; they suggest how this can be avoided.

Adult↗
PubMed2004

Segmental femur reconstruction using an intercalary allograft with an intramedullary vascularized fibula bone flap.

The use of intercalary allografts has been an important innovation for use in limb-salvage surgery. However, the principal disadvantage of intercalary allografts is a high incidence of nonunion, fracture, and infection. With a recent trend toward higher doses of chemotherapy, an increased incidence of nonunion and healing problems can be anticipated with the use of allografts. In this article, the authors report two cases in which a vascularized fibula bone flap was used with an intercalary allograft, utilising an intramedullary approach, for immediate femur reconstruction following sarcoma resection. The rationale for this approach is to combine the mechanical strength of an allograft with the biologic activity of a vascularized bone flap. The allograft provides bone stock and early stability, while the addition of the vascularized bone flap substantially facilitates the host-allograft union.

Adolescent↗
PubMed2005

Free vascularized fibula grafts in limb-salvage surgery.

The authors review the outcome of a consecutive series of 24 free vascularized fibular grafts performed as part of a limb-salvage procedure following tumor excision. There were 15 women and nine men with a mean age of 26 years (range: 6 to 52 years). The minimum follow-up was 12 months. The mean length of the graft was 13.1 cm. (range: 4.5 to 25 cm). Fifteen grafts were used in the upper limb, eight in the lower limb, and one in the pelvis. Bony union was achieved in 21/24 patients at a mean of 9.3 months. Complications occurred in 13/24 patients of whom 11 required a second operation. Four patients died of metastatic disease. The mean Musculoskeletal Tumor Society (MSTS) functional score in the remaining 20 was 84.5 percent, with 16 patients having a good or excellent outcome. Free vascularized fibula grafts offer a reliable method of reconstruction after excision of bone tumors. Although the incidence of complications appears high, they are relatively easy to correct, bony union is achieved in the majority, and functional outcome is good.

Adolescent↗
PubMed2006

Osteonecrosis of the femoral head: comparison of clinical results for vascularized iliac and fibula bone grafting.

Thirty-three patients (39 hips) with avascular necrosis of the femoral head (ANFH), who received vascularized iliac pedicle bone grafting at the Orthopaedic Department of Linkou Medical Center, Chang-Gung Memorial Hospital, were followed for more than 4 years (Group 1). Twenty-two patients with ANFH, who received free vascularized fibula bone grafting (Group 2) were followed for more than 3 years. Six parameters were adopted to evaluate the outcomes in both groups. Study results for the parameters of postoperative functional score, patient-evaluated outcome, radiographic progression, and conversion to replacement arthroplasty were not significantly different. However, the mean operation time for Group 2 was significantly longer than that for Group 1 (7 hr vs. 3.5 hr) and the mean complication rate for Group 1 was higher than that for Group 2 (8/39 vs. 1/22). Since both are palliative procedures with almost equal success rates, the easier procedure was chosen and complications carefully avoided.

Arthroplasty, Replacement, Hip↗