Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Fibula”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 109 records · Page 6Linked to original sources
PubMed1994

Influence of the fibula on growth of the rat tibia.

To investigate the effect of the fibula on growth of the tibia in the rat, (1) a sleeve of periosteum was removed from the middle third of the tibia, (2) a length of the fibula was excised, or (3) a sleeve of periosteum was removed from the middle third of the tibia and a length of fibula was also excised. Over a 14 wk experimental period subsequent tibial bone growth was measured on radiographs and compared with unoperated contralateral control tibiae. Procedure (1) had no effect on growth, (2) resulted in 4.2% overgrowth and (3) produced 19.7% overgrowth compared with control tibiae. The failure of overgrowth after periosteal resection from the middle third of the rat tibia argues against the vascular response theory in relation to bone overgrowth. The longitudinal overgrowth after procedure (2) and its further accentuation by procedure (3) suggests that the fibula influences tibial bone growth by exerting a mechanical restraint on it, which is reciprocal to the restraining influence of the tibial periosteum. Overgrowth appears to be facilitated by decompression of the cartilage growth plate of the rat tibia when a sleeve of the periosteum is removed from it, and this suggests a mechanical relationship between the fibrous periosteum and the cartilage growth plate of the tibia. It is concluded that the fibula plays a reciprocal role in regulating tibial bone growth in the rat.

Animals↗
PubMed1994

Anatomic considerations of the peroneal nerve for division of the fibula during high tibial osteotomy.

Twenty legs in 10 cadavers were dissected to determine the course of the deep peroneal nerve from its origin to its termination. Particular attention was paid to defining: (1) its relationship to palpable landmarks, (2) the angle of the course of its proximal portion against the long axis of the fibula, (3) distribution of the proximal branch to the extensor hallucis longus muscle, and (4) safe areas of osteotomy in the proximal fibula during high tibial osteotomy. The extensor hallucis longus was often supplied by only one branch from the deep peroneal nerve at 99.8 mm (31.7%) distally from the apex of the fibula; this seems to explain why osteotomy of the fibula at its proximal one third often causes paralysis of this muscle. The findings suggest that safe areas for osteotomy in the proximal fibula during high tibial osteotomy are located up to 20.5 mm (6.5%) distal to the tip of the fibular head and that the safe angle of a periosteal incision against the fibular neck area is 64.1 degrees.

Aged↗
PubMed2006

[Bilateral fibula graft. Biological reconstruction following resection of malignant bone tumors].

Bilateral vascularized fibula graft (BVFG) is actually not a satisfying method for the replacement of metadiaphyseal defects of the femur and tibia in young patients suffering from malignant bone tumors. This reconstruction was used in five patients (two female, three male, average age 15.2 years, femur n=3, tibia n=2) undergoing metadiaphyseal resection of malignant bone tumors between November 2000 and August 2003. The median length of the defect to be bridged was 16.4 cm (range 11.5-23). In the two cases of tibia reconstruction, the ipsilateral fibula was transposed into the osseous defect (fibula pro tibia). The vessels of the contralateral fibula graft were microscopically anastomosed end-to-side upon the a. and v. tibialis anterior. For the reconstruction of femoral defects, two free fibula grafts were used. All patients had multimodal treatment according to the EURO-E.W.I.N.G 99 or COSS-96 protocol. Median follow-up was at 34 months. In all cases, R0 status was achieved. None of the patients experienced local recurrence during follow-up. Radiographic signs of osseous remodeling were detected the earliest after 2 months. Full weight-bearing on the affected leg was permitted after 8-18 months. Complications occurred in four patients (bleeding 1, infection and pseudarthrosis 1, fracture 1, plate fracture 1). None of the complications led to failure of the reconstruction or to amputation. The MSTS scores was very good in two patients, good in two, and intermediate in one. Biological reconstruction of osseous defects is always desirable when possible. Good functional and durable results can be obtained using BVFG for the reconstruction of metadiaphyseal defects of the femur and tibia.

Adolescent↗
PubMed2004

Long-term follow-up of total penile reconstruction with sensate osteocutaneous free fibula flap in 18 biological male patients.

Surgical reconstruction of the penis is challenging because of the many cosmetic and functional (e.g., sexual intercourse and voiding) requirements that must be addressed. Since the free sensate osteocutaneous fibula flap was first described for total penile reconstruction in 1993 it has been widely accepted, with its advantages and minimal shortcomings. In this article, the authors present the longest follow-up of biologically male patients with free fibular phalloplasties. Since 1994, 18 biologically male patients with total penile losses for various reasons were treated with free sensate osteocutaneous fibula flaps. All patients were included in the study. The ages of the patients ranged between 20 and 26 years (mean, 22.2 years). The average follow-up period was 5.4 years (range, 1 to 9 years). Patient satisfaction was evaluated by a questionnaire regarding both quality of orgasm and daily activities. Conventional radiographic imaging, magnetic resonance imaging, and bone mineral densitometry were performed to evaluate the fate of the bony component of the flap. Also, sensibility was evaluated by bulbocavernous reflex and penile somatosensory evoked potentials testing in nine patients. Six patients married, and five of them had six children. Most patients and their partners reported pleasurable sexual intercourse and orgasm. Conventional radiographs of the fibular bone in neophalluses showed robust, calcified bone structure without any evidence of bone resorption or fracture. The magnetic resonance images showed the cortical substance and spongiosum of the bone marrow, which are characteristic signs of bone viability. After intravenous injection of gadolinium, the neophallus bone showed uptake of contrast medium. Viability of neophallus bone was shown even at 9-year follow-up (the longest follow-up in the literature). Dual energy x-ray absorptiometry measurements of the penile bone grafts showed that fibular components in the penis had bone mineral density values that were close to but lower than those of intact fibula in the same subjects. These results were considered as evidence of viability of bone grafts. Neural integrity was found between the nerves of the neophallus and the residual penile bodies by both bulbocavernous reflex and penile somatosensory evoked potentials tests. In conclusion, free sensate fibula flap phalloplasty provides the cosmetic and functional requirements that an ideal penis should have. All results put an end to the discussion that the fibular component of the neophallus could resorb. Constitution of neural integrity is important in terms of pleasurable sexual intercourse. The authors believe the free sensate osteocutaneous fibula flap should be considered as the standard in penile reconstruction.

Adult↗
PubMed2006

Clinical outcome of dental implants placed in fibula-free flaps used for the reconstruction of maxillo-mandibular defects following ablation for tumors or osteoradionecrosis.

OBJECTIVES: (a) To evaluate the clinical outcome of fibula revascularized flaps used for the reconstruction of maxillary and mandibular defects due to resection for tumors or osteoradionecrosis and (b) to evaluate the survival and success rates of implants placed in the reconstructed areas. MATERIAL AND METHODS: In a 8-year period (1995-2002), 59 patients, 38 males and 21 females, aged from 13 years to 69 years (mean age: 48.7 years), presenting with maxillary and mandibular defects due to resection for tumors or osteoradionecrosis, were reconstructed with fibula-free flaps. Of the 59 patients, 16 received 71 implants for the prosthetic rehabilitation of the reconstructed edentulous areas. RESULTS: Out of 59 fibula-free flaps, three failed and had to be removed, nine underwent partial necrosis involving the bone segment and/or the skin paddle but survived, while the remaining 47 healed uneventfully. The mean follow-up of patients after the reconstruction was 55 months (range: 24-120 months). The cumulative survival rate of fibula-free flaps was 94.9%. The mean follow-up of the 16 patients treated with dental implants and implant-supported prostheses was 50.2 months (range: 24-96 months). The cumulative implant success and survival rates of implants were 98.6% and 93.1% respectively. CONCLUSION: The reconstruction of maxillo-mandibular defects following ablation for tumors or osteoradionecrosis with fibula-free flaps has been demonstrated to be a reliable technique with good long-term results. Implants placed in the reconstructed areas were demonstrated to integrate normally, with success and survival rates comparable to those obtained in case of implants placed in native bone.

Adolescent↗
PubMed1997

[Repairing bone and soft tissue defects of the forearm with a composite segmented-fibula osteoseptocutaneous flap].

The segmented-fibula osteoseptocutaneous flap has been used to repair the bone and soft tissue defects of the forearm. During the operation, the fibula is divided subperiosteally at proper site according to the bony defects. The two segments of the fibula were then inserted to the radial and ulnar defects before vascular anastomosis is performed. Experience shows that anastomosis of only one group of vessels can ensure survival of both the segmented fibula and the cutaneous flap. Care should be taken to protect the muscle cuff and periosteum of the fibula, which is the source of blood supply to one segment. Four patients with bone and soft tissue defects of the forearm have been treated using this method. All the flaps survived with good function. The success of this technique contributes to the application of the free fibular flap in repair of forearm injury or osteomyelitis.

Adult↗
PubMed2003

[A preliminary study of maxillary reconstruction using free fibula-flexor hallucis longus myofascial flap].

OBJECTIVE: To analyze the rationale and feasibility of maxillary reconstruction using free fibula-flexor hallucis longus myofascial flap. METHODS: Nine consecutive cases of maxillary reconstruction using free fibula-flexor hallucis longus myofascial flaps from August of 2002 to August of 2003 were reviewed. Data concerning the operation included description of maxillary defect, design of the fibula flaps, recipient vessel and complications. RESULTS: One flap experienced venous thrombosis after operation, and the flap was salvaged after exploration. All the flaps survived completely with the overall success rate of 100%, as well as the 100% survival of all fibula-flexor hallucis longus myofascial flaps. CONCLUSIONS: Maxillary reconstruction using free fibula-flexor hallucis longus myofascial flap without skin paddle is feasible and reliable.

Adult↗
PubMed1993

One-stage total penile reconstruction with a free sensate osteocutaneous fibula flap.

This is the first series of total penile reconstructions with the free sensate osteocutaneous fibula flap. The main advantages of this flap lie in its intrinsic rigidity, its superior donor-site location, and its long vascular pedicle. The fibula flap provides better bone volume than does the radial forearm flap, which commonly results in a floppy phallus in the absence of bone. Penile prostheses in other flaps have enjoyed limited success. Forearm donor-site complications can be avoided. The donor site in the lower extremity can be readily covered with a sock. The vascular pedicle of the fibula flap is of sufficient length to allow end-to-side anastomosis of the flap to the femoral artery. Interpositional vein grafts are unnecessary, and dissection of the inferior epigastric artery system to serve as a donor artery may be avoided. The appearance of the neophallus is excellent. We present only the first four continuous cases of the six we have performed because sufficient follow-up data are available only for these four. The advantages and disadvantages of fibula and forearm donor sites, the long-term fate of the bony component, the importance of sensation, and the vascularized urethral reconstruction are discussed. High patient satisfaction and the advantages of the technique convince us that the fibula osteocutaneous flap is superior for total penile reconstruction.

Adult↗
PubMedDate not supplied

Use of fibula-free tissue transfer with preoperative 2-vessel runoff to the lower extremity.

OBJECTIVE: To present our experience with fibula-free tissue transfer in patients with documented 2-vessel runoff to the lower extremity on preoperative angiography. METHODS: A case series of 16 patients with segmental mandibular defects reconstructed with a fibula-free flap by the senior author with 100% stenosis of the anterior or posterior tibial arteries were retrospectively reviewed for radiographic data and complications. RESULTS: All flaps performed were successful, and there were no donor site complications. Angiography documented flow of contrast to the foot by a patent anterior or posterior tibial artery in all patients. Occlusive arteriosclerotic disease was identified in the anterior tibial artery in 10 patients and in the posterior tibial artery in 6 patients. CONCLUSIONS: Using our specific criteria, we experienced no complications with the use of a fibula-free flap in extremities with 100% obstructive vascular disease in the anterior or posterior tibial artery. Preoperative angiography is indicated to select appropriate candidates for fibula-free tissue transfer with 2-vessel lower extremity runoff to avoid potential donor site ischemic complications.

Angiography↗
PubMed2007

Variations of the nutrient artery of the fibula.

In this study the authors aimed to show variations of the nutrient artery of the fibula, which is important for more effective vascularized fibular grafts. Thirty intact legs were examined to determine the number, location, and diameter of the nutrient arteries in the shaft. In 27 of these specimens (90%) there was single nutrient artery; two legs (6.6%) had double nutrient artery. In one leg (3.3%) no nutrient artery was observed. The number of nutrient arteries found on each of the surfaces was summarized as follows. Most of the nutrient arteries pierced the fibula at its medial crest, while only one entered from the posterior surface. Most nutrient arteries were near the middle third of the fibula. The most frequent diameter of the nutrient artery was 0.9-1.5 mm. The authors think that their results about the variations of the nutrient artery supplying the fibula will contribute to the clinical and vascular anatomy knowledge.

Arteries↗
PubMed2003

Severe trismus secondary to periosteal osteogenesis after fibula free flap maxillary reconstruction.

BACKGROUND: Fibula free tissue transfer is routinely used for reconstruction of bony defects in the head and neck. During flap preparation, well-vascularized periosteum is left adjacent to the proximal vascular pedicle. It is known that periosteum can have significant osteogenic potential in the proper settings. Complications related to periosteal osteogenesis of a fibula free flap pedicle have not been previously reported. CASE HISTORY: A 12-year-old girl with a history of squamous cell carcinoma of the maxilla underwent delayed fibula free flap reconstruction of a maxillary defect. The patient had severe trismus develop postoperatively and was found to have osteogenesis along the vascular pedicle. This bone formed a solid bridge from the maxilla to the mandible. Two resections were required, which included excision of the vascular pedicle, to eliminate further osteogenesis and resolve the patient's trismus. CONCLUSIONS: The potential for periosteal osteogenesis does exist with fibula free tissue transfer and can have significant consequences. Potential promoters of osteogenesis should be identified and if possible altered in certain clinical scenarios to prevent complications from new bone growth.

Child↗
PubMed1994

Histological and radiographic determination of the age of physeal closure of the distal femur, proximal tibia, and proximal fibula of the New Zealand white rabbit.

A longitudinal study was performed in a series of 124 New Zealand White rabbits to determine the radiographic versus the histologic age of closure of the growth plates of the distal femur, proximal tibia, and proximal fibula. Periodic assessment was made by standard radiographs and histological studies. Histologically, growth plates in the distal femur closed at 19-24 weeks; growth plates in the proximal tibia, at 25-32 weeks; and growth plates in the proximal fibula, at 26-32 weeks. Radiographically, evidence of closure of growth plates in the distal femur occurred at 20-23 weeks; in the proximal tibia, at 22-27 weeks; and in the proximal fibula, at 23-31 weeks. A discrepancy in age between radiographic and histologic closure of the growth plate occurred in 3.6% of the femora, 10.9% of the tibias, and 16% of the fibulas.

Age Factors↗
PubMed1994

Fibula osteoseptocutaneous free flap in maxillary reconstruction.

The skin paddle in the fibula osteoseptocutaneous flap is thin, soft, and pliable, and it can be used for external skin coverage and intraoral linings. The flexibility of the fibula in three-dimensional positioning after multiple osteotomies is desirable in complex spatial skeletal reconstruction. The fibula osteoseptocutaneous flap is suitable for one-stage reconstruction of composite maxillary defects. The unique characteristics of the fibula osteoseptocutaneous flap and its application in the one-stage composite maxillary defect are discussed.

Adult↗
PubMed2004

Preoperative CT angiography for free fibula transfer.

The role of preoperative imaging prior to free fibula flap harvest remains controversial. The standard method of preoperative imaging has been arteriography. However, arteriography is associated with known risks and potential complications to the patient. Alternatives to traditional angiography have been sought to attempt to reduce these risks. CT angiography is a noninvasive imaging modality that can accurately assess the arterial and venous circulation, while providing images equal to those of traditional angiography. CT angiography was used in 7 patients prior to free fibula flap harvest. There were no complications from the CT angiogram or the fibula harvest. We describe our use of CT angiography for vascular imaging of the lower extremity prior to free fibula harvest.

Angiography↗
PubMed1990

[Results of the surgical treatment of chronic hematogenous osteomyelitis of the fibula].

Four hundred cases of chronic haematogenous osteomyelitis were treated by operation between 1968 and 1987. Twenty were located in the fibula. Diaphyseal resection of the fibula was carried out in 18 cases, all of which healed. The other 2 had sequestrectomy, and both relapsed. Failure of regeneration of the diaphysis after resection is of no consequence in adults, but inadequate regeneration in children will lead to elevation of the lateral malleolus and a valgus deformity of the ankle. In adults chronic osteomyelitis of the fibula should be treated by resection of the diaphysis. In children sequestrectomy is the initial treatment of choice, with resection of the fibula reserved for management of a recurrence.

Adolescent↗
PubMed1981

Observations of the blood supply to the fibula.

In the surgery of upper and lower extremities autotransplantation of the fibula is often used to bridge extensive bone defects. However, insufficient blood supply affects the long-term results. Microsurgery yields better results. We investigated the blood supply of the fibula to guarantee a careful operation method and the selection of suitable grafts. In 295 fibulae the foramina nutritiva and the periosteal vessels were investigated light microscopically. Moreover, by means of five amputation preparations the course of A. poplitea and its ramifications and of all nutritive vessels was shown roentgenologically and anatomically by popliteal angiography and stain injection, respectively. The foramina nutritiva were located as follows: 66.4% in the upper third, 15% in the middle, and 13.5% in the lower third of the fibula. Double foramina were noticed 10 times, no foramina 5 times. Consequences for the operative procedure are discussed.

Fibula↗
PubMed2004

[Free fibula transfer. Analysis of 76 consecutive microsurgical procedures and review of the literature].

Since its introduction by Taylor in 1975, microvascular free fibula transfer has become the gold standard in osseous reconstructions requiring vascularized bone transfer. Various modifications of the free fibula have been described in the literature. We reviewed a series of 76 free vascularized fibula transfers during a 7-year period. Data was retrospectively analyzed with respect to type of procedure and outcome, general surgical complications, and flap-related (specific) complications. Of all 76 free fibula flaps, 47 cases healed uneventfully (62%). Interestingly, 53% of all extremity reconstruction cases had at least one of the above complications, whereas in maxillofacial cases the complication rate was only 25%. Complete osseous consolidation at the time of evaluation was confirmed in 58 patients (76%). Complete flap failure occurred in four patients (5%). The complication rates reflect the complexity of the procedures and appear strongly related to the underlying disease and predisposing medical risk factors. Time will tell if advances, e.g., in the field of tissue engineering, will eventually replace autologous vascularized bone transfer.

Adolescent↗
PubMed1998

Lengthening osteotomy of the fibula for post-traumatic malunion. Indications, technique and results.

Relative shortening of the fibula may occur after any type of ankle fracture when the lateral malleolus is involved. Patients complain of pain and restriction of their daily and sporting activities. Clinically, there is valgus of the hind foot due to abduction and lateral rotation of the talus. The goal of treatment is to restore the initial length of the fibula by a horizontal or Z-osteotomy, which will also correct the malposition of the talus. This study shows that the operative reconstruction of a widened mortise is a relatively safe procedure, independent of the type of osteotomy used. Lengthening of the fibula is an important step in the treatment of the painful ankle when the fibula is short after trauma, even when degenerative changes of the joint are already present.

Adult↗