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PubMed1995

Skin paddle salvage in the fibula osteocutaneous free flap with secondary skin paddle vascular anastomosis.

The fibular osteocutaneous free flap has become a popular choice for the reconstruction of bone and skin defects. A potential drawback has been the reported unreliability of the skin paddle. Previous studies have emphasized total loss of the overlying skin paddle, if the expected perforating vessels are not present either in the intermuscular septum or in the soleus. Two cases are presented in which the skin paddle was found to be supplied by vessels arising from the proximal peroneal artery. there were no intraseptal or intramuscular vessels in the osteocutaneous septum which connected to the overlying skin paddle. The skin island was salvaged by performing independent microsurgical anastomoses of the fibular graft and the skin paddle. Both patients had complete survival of the fibula and overlying skin paddle.

Aged↗
PubMed1986

Treatment of tibial defect with vascularized osteocutaneous pedicled transfer of fibula.

Free osteocutaneous fibular flap transfer has been used for long bone and soft tissue defects in both the lower and upper extremity. Since July, 1984, two cases of tibial defect, with severe scar formation on the anteromedial aspect, have been treated. An ipsilateral, vascularized, osteocutaneous, pedicled flap of the fibula was used to bridge the bony defect and to resurface the wound, after scar excision and bony debridement. The peroneal vessels were severed, leaving one side intact. The entire fibular flap was shifted anteromedially through a tunnel between the anterior and posterior tibialis. In addition to screw fixation of both ends of the transfer, an external fixator was used for three months. This technique has the advantages of obviating the need for vessel anastomoses and of completing the whole procedure on a single leg.

Adult↗
PubMedDate not supplied

[Treatment of congenital tibial pseudarthrosis using a free vascularized fibula transfer and plate osteosynthesis. Case report].

Congenital pseudarthrosis of the tibia is a rare disorder of unknown etiology. The free vascularized fibula-pro-tibia-transplant permits correction of the defect and the leg length-discrepancy during one surgical procedure. A 5 year old girl with congenital pseudarthrosis underwent a free vascularized fibular-pro-tibia-transplant. At a follow-up examination 5 years post surgery she had no subjective complaints, she walked without external orthopaedic support, there was no leg length-discrepancy. As stated in the literature the rates of bony unions are much higher than after conventional methods.

Bone Plates↗
PubMed2001

Tibia fracture after fibula resection for distal peroneal bypass.

The lateral approach to the distal peroneal artery has been used by vascular surgeons for 25 years. No complications specifically related to this approach have previously been reported. We reviewed 18 cases of peroneal bypass for limb salvage using the lateral approach with fibula resection and found that two of these cases had ipsilateral tibia fractures within 1 year of the bypass. Eight out of 18 cases were women, and two of these eight had tibia fracture. Both women suffered from osteoporosis. We conclude that tibia fracture is a possible complication of this approach, especially in elderly women with osteoporosis.

Aged↗
PubMed2002

Tumors of the head of the fibula: good function after resection without ligament reconstruction in 6 patients.

Tumors of the proximal fibula are rare. Wide resection includes adjacent knee-stabilizing structures. Unlike treatment of traumatic disruption of the lateral ligamentous structures of the knee, wide resection of the fibular head for a tumor may not require reconstruction. After 14 years of follow-up, function was satisfactory in 6 consecutive cases where resection of the fibular head was done without ligamentous reconstruction.

Adult↗
PubMed2001

Donor site angiography before mandibular reconstruction with fibula free flap.

The use of fibular free flaps has become established as a reliable and popular method for reconstruction of segmental mandibular defects. The role of routine preoperative angiography remains controversial. Sixty four digital subtraction angiograms were studied in a series of 39 consecutive patients clinically judged to be satisfactory candidates for fibula free transfer. Angiographic findings revealed vascular anomalies in 10 extremities (15.6%). Regarding the high potential for significant donor site morbidity authors consider vascular imaging essential part of preoperative evaluation.

Adolescent↗
PubMed2004

Free fibula flap mandible reconstruction in benign mandibular lesions.

The mandible may be affected by a variety of pathological conditions such as ameloblastomas, odontogenic keratocysts, central giant cell granulomas, fibro-osseous lesions, and osteomas. They generally are benign, and conservative treatment can be enough in most of the cases. However, they can be clinically aggressive, and especially ameloblastomas, odontogenic keratocysts, and fibro-osseous lesions are prone to recur. The method of treatment remains a matter of controversy in these cases. The aim of this analysis was to study 100 patients who had been treated for benign mandibular lesions, and to emphasize the importance of free fibula flap in the treatment of such lesions.

Adolescent↗
PubMed1984

Scintigraphic skeletal "doughnut" sign due to giant cell tumor of the fibula.

Although the "doughnut" sign in brain scintigraphy is a well known phenomenon, similar findings have recently been reported in bone scintigraphy in osseous and nonosseous lesions. A skeletal doughnut sign in bone scintigraphy caused by giant cell tumor of the proximal fibula is presented with a brief review of literature.

Adult↗
PubMed2006

Free fibula and corticocancellous bone grafting for salvage of a war-injured forearm.

The treatment of a complex forearm injury inflicted by a wartime mine explosion is presented in this study. Apart from the soft tissue damage, a 4-part fracture of the radius and loss of 19 cm of the ulnar diaphysis were present along with lesions of the median and ulnar nerves. The radial pulse was intact. The first formal treatment of the wounding consisted of extensive soft tissue and bone debridement and external fixation of radius with an additional intramedullary K-wire. After wound closure was obtained, a free vascular fibula grafting of the ulna and corticocancellous bone grafting of the radius were performed. Bone union of both the radius and ulna was subsequently achieved and 9 years after the injury, the patient has full flexion and extension of the elbow, full pronation and 70% of supination. Motion of the wrist is limited because of an ulnar plus variant of the distal radioulnar joint. Hand function is still limited by chronic low-moderate median nerve palsy, but the ulnar nerve has recovered completely. The patient is able to pinch, has full finger extension and can make a fist. He is satisfied that he made the correct decision in not having an initial amputation for his injury.

Adult↗
PubMed1980

False aneurysm of the posterior tibial artery complicating fracture of the tibia and fibula.

A false aneurysm of the posterior tibial artery associated with a fracture of the tibia and fibula is described. A review of the English language literature of the last 15 years revealed only six other similar cases. The physician should bear in mind that a persisting painful swelling at the fracture site of the leg might be the only clinical sign of a false aneurysm developing in one of the tibial vessels.

Aneurysm↗
PubMed1999

Stress fracture of the proximal fibula in a young soccer player: a case report and a review of the literature.

A 14-yr-old soccer player complained of a history of leg pain with activity that had been present for several weeks. There was no history of direct trauma. Tenderness was found over the lateral aspect of the leg, and radiographs showed an area of calcification along the shaft of the proximal fibula. Because of the unusual location of the findings and to exclude a tumor, magnetic resonance imaging (MRI) was obtained which confirmed the diagnosis of a proximal fibular stress fracture. The patient returned to full sport participation with a period of relative rest, splinting, and strengthening and flexibility training. This case describes an injury that has not been reported in young athletes and only rarely described in active adults. The literature regarding this injury is reviewed, and two injury patterns of proximal fibular stress fractures are described.

Adolescent↗
PubMed1986

Heterotopic microvascular growth plate transplantation of the proximal fibula: an experimental canine model.

The reconstructive potential of microvascular transplantation of skeletal growth plates was investigated through heterotopic transfers. The distal radius was resected in two series of puppies of a known large breed and substituted with a microsurgically revascularized transplant from the proximal fibula. Evaluation was conducted through serial roentgenograms, goniometric registration of joint mobility, volume measurements, histology, and fluorescent bone labeling. In the first series, development of neuropathic-like destruction of the weight-bearing graft ensued in the majority of the animals. In the second series, prolonged protection from weight bearing inhibited this destruction and resulted in hypertrophy of the revascularized epiphyseal end of the transplant but clearly reduced longitudinal growth, with only one transplant exhibiting longitudinal growth that exceeded 50 percent of the value for the control. This experiment demonstrates that skeletal growth plates possess a capacity for hypertrophy under the influence of increased loads. Whether this adaptability is sufficient to allow microvascular transplantation of growth plates to become a clinically useful procedure in children remains unclear. Further laboratory investigations are mandatory prior to clinical application of microvascular transfers of epiphyseal growth plates.

Animals↗
PubMed1989

Difficult reconstruction of an extensive injury in the lower extremity with a large cross-leg microvascular composite-tissue flap containing fibula.

In the absence of proper recipient vessels, a large microvascular composite-tissue flap was transferred successfully for reconstruction of a leg with an extensive crush injury. This was accomplished by using vessels of the normal leg. The microvascular flap containing skin, muscle, and 15 cm of fibula survived well after division of the pedicle. To achieve good bone healing, the leg was protected by a brace while gradually increasing weight bearing. The functional result is satisfactory.

Adolescent↗
PubMed1995

Functional reconstruction of a bilateral maxillectomy defect using a fibula osteocutaneous flap with osseointegrated implants.

We have achieved functional reconstruction for a bilateral upper alveolar bone, gingival, and palatal defect that has various problems originating from instability of the prosthesis using the fibula osteocutaneous flap with osseointegrated implants. The flap had three bone segments and two skin paddles. The combined bone segments created the upper alveolar arch, and the skin paddles closed the palatal defect. Nine months later, prosthodontic treatment was performed successfully. Our procedure restored the patient to masticatory function of the upper jaw, intelligible speech, and natural facial appearance. As a result, quality of life of the patient was extremely improved.

Dental Implantation, Endosseous↗
PubMed1996

Free fibula flap mandible reconstruction for oral obstruction secondary to giant fibrous dysplasia.

Fibrous dysplasia is a disorder of bone that may be associated with endocrinopathies and skin pigmentation. The pathologic, proliferative expansion and distortion of the skeleton is of unknown etiology. Craniofacial involvement that includes the mandible can exhibit gigantic disproportions and dysfunction. Treatment has evolved to include more aggressive strategies of resection and sophisticated reconstructive techniques. The reported case is noteworthy for the unrelenting growth of craniofacial fibrous dysplasia in an adult female with endocrinopathies, progressing to oral obstruction that required urgent treatment utilizing immediate free bone-flap reconstruction. The free fibula flap was employed to restore mandibular continuity after palliative subtotal mandibulectomy. Bony healing to dysplastic tissue occurred in the remaining mandibular segment. This case illustrates that fibrous dysplasia has the capacity for virulent regrowth subsequent to conservative resection. Defects following radical surgery for giant fibrous dysplasia of the mandible can be reconstructed with a microsurgical bone-flap technique.

Adult↗
PubMed1999

Functional reconstruction after a total maxillectomy using a fibula osteocutaneous flap with osseointegrated implants.

The fibula osteocutaneous flap with osseointegrated implants was used for reconstruction of a total maxillectomy defect. We have achieved satisfactory reconstruction of three-dimensional facial structure, orbit support, and a functional prosthesis. Our procedure restored the patient's masticatory function of the maxilla and enabled good speech and a natural facial appearance. A very high quality of function was obtained without any complications, but long-term follow-up is necessary for maintenance of the implants.

Aged↗
PubMed2001

Bipedicled vascularized fibula flap for proximal humerus defect in a child.

Vascularized bone transfer is becoming the most important option in the many cases in which durable, long-standing bone reconstruction is needed. The transfer of the vascularized epiphyseal plate, although controversial, is advantageous in cases where future growth is needed (i.e., congenital anomalies and tumor resections in children). The use of the free fibular head flap, based on epiphyseal blood supply augmentation, was reported using the anterior tibial artery, or part of it, as the nutritional vessel. By using both the peroneal artery and the specific branch to the fibular head as a bipedicled free flap, we ensured both long-bone fibula reconstruction and augmented blood supply to the head. We report a case of subtotal resection of the humerus due to osteosarcoma in a child that was reconstructed by this method. A preoperative study was conducted on fresh cadavers to identify the specific pedicle of the fibular head. The biceps femoris tendon was used to better stabilize the shoulder joint. The child recovered well and showed good progress in rehabilitation. On follow-up 1 year postoperatively, the shoulder joint remained limited, but showed no signs of substantial remodeling on x-ray. Good elbow and wrist-hand functions were noted. The child developed a single lung metastasis that was also removed. The question remains if the theoretical advantages in bone remodeling, shoulder stability, and bone growth are worth the extra time of surgery or the possible added donor and recipient site complications.

Bone Neoplasms↗