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At least 91 records · Page 5Linked to original sources
PubMed2004

[Reconstruction of posttraumatic bony defects of the lower extremity: callotaxis or free vascularized fibula graft?].

PURPOSE/BACKGROUND: Several methods have been established for the treatment of bony defects of the lower extremity. The purpose of this paper is to evaluate the use of a free vascularized fibula graft for these defects in comparison to callotaxis and segmental transport. METHOD AND CLINICAL MATERIAL: Retrospective analysis of data from 32 patients treated between 1981 and 1999 at the University Hospital in Zurich, Switzerland with bony defects of the lower extremity. RESULTS: The reconstruction of the bony defect was successful in 80 % with fibula graft, in 94 % with callotaxis and in 83 % with segmental transport. In the group with the fibula transplantation 2.6 re-interventions due to complications had to be performed, in the callotaxis group there were 3.6 and in the segmental transport group 5.2 surgical re-interventions. The time between primary intervention and full weight bearing was 16 months in the fibula transplantation group, 7.6 months in the callotaxis group and 10.7 months in the segmental transport group. CONCLUSION: The results show that these three options can be used for different indications. Reconstruction can be planned according to the following rules: Segmental bony defects of the entire circumference of up to 5 cm are best treated by initial shortening followed by callus distraction. Bony defects from 5 to 12 cm are best treated by segmental transport while maintaining limb length. Defects > 12 cm are best treated by reconstruction with a vascularized free fibula graft.

Accidents, Traffic↗
PubMed2005

Fibula osteoseptocutaneous flap with a variant perforator and peroneal artery arising from the anterior tibial artery.

Since the report of the first cases of vascularized free fibula graft for treatment of open fracture of the tibia and fibula in 1975, there have been many other reports of the use of vascularized free osteocutaneous fibula flaps for reconstruction of the mandible or lower leg. Usually, these flaps have a single pedicle composed of the peroneal artery, to supply the fibula with septocutaneous or musculocutaneous branches arising from the peroneal artery to supply the lateral skin of the leg. Although some authors have reported variant perforators, there have been no reports of the peroneal artery arising from the anterior tibial artery and perforator arising from the posterior tibial artery. This is the first report of a variant of the peroneal artery and perforator using a vascularized free osteocutaneous fibula flap.

Combined Modality Therapy↗
PubMed1998

External fixation of tibial plafond fractures: is routine plating of the fibula necessary?

OBJECTIVES: To determine the advantages and disadvantages of plating an associated fibula fracture in tibial plafond fractures treated with external fixation that spans the ankle. STUDY DESIGN: Retrospective clinical review. METHODS: The incidence of treatment complications and the outcomes achieved were compared between two groups of patients with tibial plafond fractures and associated fractures of the fibula. Both groups were treated by a uniform technique of monolateral external fixation. One group, consisting of twenty-two patients with twenty-two fractures, had plate fixation of the distal fibula and the other group, thirty-one patients with thirty-two fractures, had no fibular fixation. RESULTS: The demographics of the two groups, including sex, fracture classification, and number of open fractures, were similar. The outcome of the two groups for radiographic arthrosis and clinical ankle score, measured at minimum two-year follow-up, showed no statistically significant difference. The total numbers of complications were not statistically different between the two groups (p = 0.15), but the types of complications varied. Group I had eight complications: five fibular wound infections, two fibular nonunions, and one angular nonunion. Group II had seven complications: six angular malunions and one tibial wound infection. CONCLUSION: Open reduction and internal fixation of the fibula fracture in tibial plafond fractures treated with external fixation that spans the ankle is associated with a significant rate of complications, and good clinical results may be obtained without fixing the fibula.

Adolescent↗
PubMed1995

Donor leg morbidity and function after fibula free flap mandible reconstruction.

The purpose of this study was to determine the donor leg morbidity and function after removal of the fibula free flap for mandible reconstruction. In the past 24 months, 29 consecutive patients underwent a total of 30 fibula free flap mandible reconstructions. A muscle-sparing technique was used to harvest the fibula flap, and the proximal 6 cm and distal 8 cm of fibula were left intact. Patients included 20 men and 9 women; their mean age was 58.8 years (range 29 to 82 years); the mean length of fibula removed was 14.5 cm (range 8 to 25 cm); osteocutaneous flaps were used in 27 patients (90 percent); and 16 patients (53 percent) required skin grafts to the donor leg. Donor leg morbidity and function were determined by patient questionnaire, physical examination, and isokinetic testing, with the opposite, unoperated leg serving as a control. Immediate postoperative morbidity occurred in 5 patients (17 percent) (infection, wound separation, or partial graft loss); none required additional surgery for donor complications. Patient questionnaires were completed by all patients at an average of 7.3 months after surgery. Patients were able to ambulate pain-free an average of 5.1 weeks (range 2 to 32 weeks) postoperatively and were all fully able to engage in all daily and recreational activities. Most (21 patients, 72 percent) were free of any donor pain, and the remainder (28 percent) had only occasional mild discomfort. Other complaints included ankle stiffness (41 percent), mild ankle instability (10 percent), and transient peroneal motor (7 percent) or sensory (28 percent) loss, which resolved in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Combined anterolateral thigh flap and vascularized fibula osteoseptocutaneous flap in reconstruction of extensive composite mandibular defects.

Extensive composite defects of the oromandibular area are usually created after the surgical treatment of T3 and T4 cancers, requiring complex reconstructive plastic surgical procedures. The preferred treatment method for this type of defect is reconstruction with two free flaps. The use of the vascularized fibula osteoseptocutaneous flap for the bone and inner lining defect is well known and accepted. Among the flaps that can be used for the outer lining and soft-tissue reconstruction, the two most commonly used have been the forearm flap and the rectus abdominis myocutaneous flap. However, these flaps have some disadvantages that restrict their use for this purpose. The forearm flap is usually too thin to cover the fibular bone and reconstruction plate, and the rectus abdominis myocutaneous flap can cause a subclinical reduction in abdominal strength. Both radial forearm and rectus abdominis myocutaneous flaps are difficult to harvest during tumor excision. Because of these drawbacks, over the past several years the authors have preferred to use the anterolateral thigh flap for outer face, neck, and submandibular region reconstructions. From October of 1998 to June of 2000, 22 extensive composite mandibular defect reconstructions using the free anterolateral thigh flap, combined with the vascularized free fibula osteoseptocutaneous flap, were performed at the Chang Gung Memorial Hospital. Complete flap survival was 90.9 percent (40 of 44 flaps). Complete loss was seen in an anterolateral thigh flap, which was then reconstructed with a pectoralis major myocutaneous pedicled flap (2.3 percent). There were five venous problems: three in osteoseptocutaneous free fibula flaps, the other two in anterolateral thigh flaps; all were revised immediately. However, the skin islands of two osteoseptocutaneous free fibula flaps and one anterolateral thigh flap developed partial necrosis (6.8 percent). The other complications were compartment syndrome in the leg in one patient, external carotid artery rupture in one patient, three donor-site infections in two patients, three neck wound infections, and one myocardial insufficiency; all were treated properly. Thirteen patients underwent revision procedures 6 months after the first operation. These procedures included debulking of the flap or revision of the mouth angle or both. Trismus or intraoral contraction was noted in none of these patients. In conclusion, the free anterolateral thigh flap combined with the vascularized fibula osteoseptocutaneous flap seems to be a good choice in the reconstruction of the extensive composite defects of the oromandibular region aesthetically and functionally.

Aged↗
PubMed2007

Pasteurized intercalary autogenous bone graft combined with vascularized fibula.

The optimal reconstruction procedure after wide resection of bone tumors is debatable. We reviewed pasteurized intercalary autogenous bone graft combined with a vascularized fibula graft in 15 patients with malignant bone tumors, and assessed whether this procedure would improve bone union and function. The mean duration until bone union of the pasteurized autogenous bone was 13.5 months and duration until union of the vascularized fibula was 7.7 months. Complete bone union between the pasteurized autogenous bone and the vascularized fibula eventually was achieved in 13 patients (86.7%). In the remaining two patients, fibula union was achieved but union of the pasteurized autogenous bone was not attributable to infection. Postoperative complications included two fractures and two infections. Three patients with delayed union eventually achieved bone union using an autogenous cancellous bone graft. The mean Musculoskeletal Tumor Society score was 80.6% and it was comparable to scores from other procedures. Our results suggest a pasteurized autogenous bone graft combined with a vascularized fibula graft can be a useful reconstruction method in selected patients with large bone defects after wide resection of malignant bone tumors.

Adolescent↗
PubMed2006

Settling of fibula strut grafts following multilevel anterior cervical corpectomy: a radiographic evaluation.

STUDY DESIGN: This is a retrospective study of settling of fibula strut grafts used for anterior cervical reconstruction. OBJECTIVE: To measure settling and kyphotic angulation of uninstrumented fibula strut graft reconstruction for two- and three-level cervical corpectomy procedures. SUMMARY OF BACKGROUND DATA: Clinical experience indicates that some settling of anterior fibula strut grafts used in anterior cervical reconstruction will occur. The amount of settling and subsequent kyphosis using this technique has not been documented in the literature. METHODS: Twenty-six patients having had nonvascularized autogenous fibula strut grafting without instrumentation following a two- or three-level corpectomy were studied. Baseline radiographic measurements of height and angulation on postoperative radiographs before hospital discharge were compared with measurements performed at least 2 years after surgery. Clinical follow-up was also available on all patients. RESULTS: The average settling manifested by loss of height across the fused segments was 6.7 mm (standard deviation, 5.71 mm). The average change in angulation was 2.5 degrees into kyphosis (standard deviation, 6.09 degrees ). Loss of height and angulation were not statistically different for two- versus three-level corpectomy patients. Pain outcomes did not correlate with the amount of settling or angulation. CONCLUSIONS: Some settling of autogenous fibula strut grafting without instrumentation can be expected. These findings did not correlate with residual postoperative axial neck pain.

Adult↗
PubMed2003

Osteotomy to treat malocclusion following reconstruction of the mandible with the free fibula flap.

Malocclusion may result after free fibula flap reconstruction of the mandible, because of inadequate positioning of the temporomandibular joint, inaccurate contouring of the reconstruction plate, or subsequent fracture of a miniplate. Factors that alter the vascularity of the transplanted fibula may also result in a delayed presentation of malocclusion. Seven cases are presented, in which primary surgical treatment consisted of segmental mandibulectomy and reconstruction with a free fibula osteoseptocutaneous flap. Fixation was achieved with a reconstruction plate in five cases and a miniplate in two cases. Malocclusion was corrected with an osteotomy performed at the junction of the fibula and the native mandible. The new osteotomy sites were fixed with miniplates and maintained with intermaxillary fixation. Complete bony union was achieved at the osteotomy sites. The correction of malocclusion was successful in all cases, and all patients have resumed a normal diet. This report demonstrates that osteotomy and realignment of the mandible are effective for the secondary correction of malocclusion after mandibular reconstruction with the free fibula osteoseptocutaneous flap.

Adult↗
PubMed2006

Use of the microvascular free fibula transfer as a salvage reconstruction for failed anterior spine surgery due to chronic osteomyelitis.

BACKGROUND: Several factors influence the osseous union of spinal fusions, including the substrate used for arthrodesis, the biology of the fusion bed, as well as local host factors. While cancellous bone grafting is useful in simple cases with no major bony defects, corticocancellous strut grafts are indicated in reconstructions requiring mechanical support. The size and location of the spinal defect to be reconstructed determine what type of vascularized bone graft is indicated. According to the literature, locations suitable for reconstruction using a microvascular free fibula graft include the cervical spine and, less frequently, the cervicothoracic, thoracic, thoracolumbar, and lumbar spine. Using the microvascular free vascularized fibula graft as a salvage procedure for failed anterior spine surgery due to bacterial spinal osteomyelitis has not been reported. METHODS AND RESULTS: Four cases of spinal osteomyelitis after attempted spinal fusion are presented. In all cases, a microvascular free fibula graft was successfully used for secondary spinal fusion and clearance of documented bacterial osteomyelitis. The operative approach is described. CONCLUSIONS: Use of the vascularized free fibula graft for correction of primary and secondary spinal deformities, as well as for reconstruction after excision of malignant spine tumors, has been well documented. On the basis of their experience, the authors also recommend microvascular fibula transplantation as a salvage procedure for failed anterior spine surgery due to chronic osteomyelitis.

Aged↗
PubMed2000

Pre-operative evaluation of the lower extremity prior to microvascular free fibula flap harvest.

The microvascular free fibula flap, is currently one of the preferred methods for reconstruction of the oromandibular defect. The patency of the major vessels in the donor limb should be evaluated before the fibula is harvested because the blood supply can be inadequate to safely utilise this flap. The best method of evaluating, pre-operatively, the lower limb vasculature is controversial. Femoral angiography has been considered as the gold standard, however, the current literature advocates less invasive methods of assessment such as magnetic resonance angiography and colour flow Doppler. A postal questionnaire was sent to all members of The British Association of Head and Neck Oncologists asking details of the preferred method of lower limb vascular assessment prior to fibula flap harvest. Of 137 responses, 48 performed free fibula flaps. Of these 48 surgeons, the preferred method for evaluation was palpation of pulses combined with either angiography (40%) or Doppler on the ward (38%). None of this subgroup of surgeons utilised colour flow Doppler as a first line investigation despite this being available to 67% of responders. This survey highlights the diversity in pre-operative assessment amongst surgeons performing fibula flaps for head and neck malignancy. Few relied on clinical examination alone; however, the less invasive methods of vascular imaging were seldom utilised.

Bone Transplantation↗
PubMed2000

[Reconstruction of the mandible and soft tissue defects with the osteomyocutaneous free fibula flap].

OBJECTIVE: In order to ascertain a material that is ideal both for reconstruction of the composite mandibular defects and for osseointegrated implantation. METHODS: Fifteen osteomyocutaneous fibula flaps were transferred for reconstruction of the mandible and surrounding soft tissues. The characters of the blood supply of the flap, the operation course, the relation of the fibula and dental implants were observed. RESULTS: The osteomyocutaneous fibula flap was supplied by double vessels. The blood supply was reliable even after the fibula was cut into several segments. Periosteal circulation was its main blood supply. The postoperative contour and function of the mandibular region were good. The flap also favours dental implants and denture. CONCLUSION: The osteomyocutaneous fibula flap was the ideal material to reconstruct the defects of mandible and surrounding soft tissues.

Adult↗
PubMed2002

[Function of fibula in stability of ankle joint].

OBJECTIVE: To summarize the function of fibula in stability of ankle joints. METHODS: Recent original articles were extensively reviewed, which were related to the physiological function and biomechanical properties of fibula, the influence of fibular fracture on stability of ankle joints and mechanism of osteoarthritis of ankle joints. RESULTS: The fibula had the function of weight-bearing; and it was generally agreed that discontinued fibula could lead to intra-articular disorder of ankle joint in children; but there were various viewpoints regarding the influence of fibular fracture on the ankle joint in adults. CONCLUSION: Fibula may play an important role in stability of ankle joint.

Ankle Joint↗
PubMedDate not supplied

Interface of unloaded titanium implants in the iliac crest, fibula, and scapula: a histomorphometric and biomechanical study in the pig.

PURPOSE: Prefabrication of free vascularized fibular flaps is a 2-stage procedure for the reconstruction of maxillary and mandibular defects. The delay between prefabrication and flap transfer is 6 weeks and depends on biomechanical stability and osseointegration of the implants. The purpose of this animal study was to evaluate implant stability by measuring the removal torque values (RTVs) at 3, 6, and 12 weeks and to compare the results with interface strength of the bone-implant surface in the fibula, the scapula, and the iliac crest under unloaded conditions. MATERIALS AND METHODS: ITI implants (n = 108) with a sandblasted and acid-etched surface were placed in the fibula, the scapula, and the iliac crest of 6 Yorkshire pigs. Biomechanical, histologic, and histomorphometric results were collected at 3, 6, and 12 weeks, respectively. RESULTS: Bicortical anchored 8-mm implants in the fibula (63.7 to 101.8 Ncm) showed RTVs similar to those of monocortical anchored 12-mm implants in the scapula (62.3 to 99.7 Ncm). The RTVs of monocortical anchored 8-mm and 10-mm implants in the iliac crest (19.1 to 44.3 Ncm) and the scapula (27.2 to 55.3 Ncm) were significantly lower. The bone-to-implant contact in the fibula at 3, 6, and 12 weeks (35.2%, 44.4%, and 46.8%, respectively) was similar to that in the iliac crest (24.2%, 44.2%, and 52.5%, respectively), but significantly lower than in the scapula (63.7%, 73.8%, and 74.2%, respectively). DISCUSSION AND CONCLUSION: Bicortical anchorage determined implant stability in the fibula, whereas interfacial strength seemed to define stability in the scapula. The quality and type of bone determined the bone's response in terms of biomechanical press fit or biologic interface strength.

Animals↗
PubMed2004

[One-stage reconstruction of bilateral mandibular with free fibula flap].

OBJECTIVE: To explore the method of clinical application and the efficacy of free fibula osteomyocutaneous flap in one-stage reconstruction of transmidline bilateral mandibular defect caused by giant neoplasms. METHODS: From july 2000 to october 2002, transmidline bilateral mandibular defects caused by ameloblastoma (4 cases) and gingival carcinoma (2 cases), according to the character of defects, were reconstructed with free fibula osteomyocutaneous flaps. Peroneal artery and vein were used as vascular pedicle, the fibula was reshaped, and micro-titanium plates were used in rigid fixation between fibula and residue of bilateral mandible. Microvascular anastomoses were carried out between peroneal artery/vein and small artery/vein in neck. RESULTS: Six free fibular osteomyocutaneous flaps survived well. Follow up duration ranged from 6 months to 2 years, the lower face appearance recovered well, occlusion relationship were normal, all patients were satisfactory with appearance and chewing function after repair of removable denture. CONCLUSION: Free fibular osteomyocutaneous flap is a favorable material in the reconstruction of transmidline bilateral mandibular giant defect. The blood supplement of fibula is offered both by segmentral periosteum and nutrient artery from bone marrow, It is greatly benefit to reshaping as arched mandible.

Adult↗
PubMed1990

Fibula dimelia in association with ipsilateral proximal focal femoral deficiency, tibial deficiency, and polydactyly. A case report.

A 16-year-old girl with bilateral tibial deficiency, left fibula dimelia, left proximal focal femoral deficiency, polydactyly, and congenital heart disease is now ambulatory and able to attend public school. This combination of anomalies has been overcome by cardiac surgery followed by Boyd-type amputation, prosthetic restoration, and therapy. The shortened left distal femur was lengthened by implanting both amputation fibulae proximally. In the same surgery, the amputation os calcis was fused distally to these fibulae. The right fibula was disarticulated at the knee. The female patient was fitted with bilateral knee disarticulation prostheses. She became fully ambulatory with a walker, progressing to bilateral forearm crutches. Recurrent deformity at the fusion site of the left femoral segment to the fibulae required a subsequent wedge osteotomy and multiple surgeries during the years following. Today she remains ambulatory with the use of nonaxillary crutches, attends public school, and is without pain. She takes part in athletics within the range of her abilities and hopes to obtain a driver's license and use a modified car. She is independent and well adjusted. Her progress has been followed from the age of 11-and-one-half months to present.

Abnormalities, Multiple↗
PubMed1979

[Margins and torsion of the human fibula].

The borders and ridges of the fibula show a difficult aspect caused by the bone-forming musculature. These structures are an occasion for misunderstanding and mistaken denominations, which even had a noticeable effect on the PNA. Two thirds of all human fibulae exhibit a clearly prominent 'crista musculi tibialia posterioris', giving tendinuous attachment to the tibialis posterior muscle. In diagnosis of borders this crista may lead to errors, because it branches off from the interosseous border underneath the upper fourth of the fibula and reaches the medial crest in the middle of the bone. Most of the borders of the fibula show a twisted course corresponding to the direction of the shaping musculature and effecting a fictitious torsion of the shaft. The proper torsion of the fibula, however, is substantiated by the difference between the absolute torsion (= twist of the two ends of the bone) and the accompanying torsion (= twist enforced by the torsion of the tibia).

Biomechanical Phenomena↗
PubMed1980

[Compensatory movements of the fibula necessitated by the wedge shape of the trochlea tali].

The lateral articular facet of the talus (Facies malleolaris lateralis) is slanting and irregularly shaped; therefore, the fibula shows compensative motions in transverse, sagittal, vertical and rotational directions when the ankle joint is moved. There are contradictory statements concerning the course of this compensative rotation, because the fibula shows individually different reactions. The fibula is not rotated during dorsiflexion in nearly 25% of legs; approximately one half of the remaining fibulae is rotated outward, the other half inward. The matter of fact is not surprising, when the shape of the lateral articular facet is inspected exactly: it resembles a flat saddle, the anterior part of which is screw-shaped. The fibula rotates outward during dorsiflexion, if the furrow of this screw-shaped area increases forward; it rotates inward, if the furrow diminishes forward; and it does not rotate at all, if the furrow is constant.

Ankle Joint↗
PubMed1995

A review of 60 consecutive fibula free flap mandible reconstructions.

Sixty consecutive fibula free flap mandible reconstructions were performed for oncologic defects. Patient age averaged 46.7 years. Eighty-one percent were primary reconstructions. Sixty-two percent were lateral defects; 22 percent were anterior; and the remainder had combined defects. The bone gap averaged 9.4 cm. A skin island was included with the fibula in 85 percent of patients but was actually needed in only 62 percent. Miniplate fixation was used in 96 percent. Templates derived from radiographic studies were used as an aid in shaping the fibula. Average anesthesia time was 14.54 hours; the transfusion requirement, 3 units; and hospitalization, 22 days. Fifty-nine flaps were successfully transferred. Ninety percent of skin islands raised were completely viable. Average postoperative interincisal opening was 35.2 mm. Osseointegrated implants were placed in 56 percent of suitable candidates, and all implants integrated into bone. Aesthetic results were usually good when the soft tissue defect was limited, but poor when it was extensive. Donor site morbidity was usually mild and transient. The most significant problem was delayed healing in patients closed with a skin graft. Postoperatively, all patients ambulated normally, and none used assist devices. Reoperation for donor site problems was rare. The fibula has many assets that together make it an ideal choice for the reconstruction of most mandible defects. The skin island is usually reliable if it is designed and raised properly. Donor site morbidity is largely inconsequential. The primary contraindication to the use of the fibula for mandible reconstruction is severe peripheral vascular disease.

Adolescent↗