Reconstruction of Large Bone and Soft Tissue Defect Combined with Infection in the Lower Extremity with Free Flap Followed by Ipsilateral Vascularized Fibular Transposition

PURPOSE: The aim of this study is to report on the results and discuss the role of free flap followed by ipsilateral vascularized fibular transposition (IVFT) for reconstruction of large bone and soft tissue defect combined with infection by open tibia fracture. MATERIALS AND METHODS: During the research period, lasting from December 2002 to June 2008 (Kyung Hee University Medical Center), data were collected from three patients who underwent IVFT after free flap. We analyzed the successiveness and persistency of the infection using free flapping, bone union, and hypertrophy between transposed fibula and tibia. RESULTS: Regarding free flap, successive results were observed in all examples. In the final follow-up results, transposed fibulas all survived, having hypertrophy similar to that of adjacent tibia. CONCLUSION: Reconstruction of tibia defect with free flap followed by IVTF is a useful and safe method for avoidance of the potential risk of infection for patients with a large tibial bone defect and soft tissue defect associated with infection.

Reconstruction of Tibia Defect with Free Flap Followed by Ipsilateral Vascularized Fibular Transposition

Segmental defects of the tibia after open fractures, sepsis and a tumor surgery are among the most difficult and challenging clinical problems. Tibia defects in these situations are complicated with infection and are resistant to conventional bone grafting techniques. The aim of this study is to report the results and discuss the role of free flap followed by ipsilateral vascularized fibular transposition (IVFT) for reconstruction of tibia defects. Ten patients had free flap followed by IVFT in the period 1989~2007. Mean age was 25.3 years. The patients were followed for an average of 3.4 years. All flaps were survived including 1 case with venous thrombosis requiring additional surgery. The average time to union of proximal and distal end was 5.2 months, 8.2 months, each other. All transposed fibula were viable at last follow-up. IVFT offers the advantages of a vascularized graft. In patients with large bone and soft tissue defects combined with infection, free flap followed by IVFT is an useful and reliable method without microvascular anastomosis.

Vascularized Fibula Graft for Restoration of the Large Bone Defect / 대한정형외과학회잡지

We analyzed 34 cases of large bone defect caused by trauma, infection and tumor resection from July, 1979 to June, 1985. The bony defect were restored by vascularized fibular graft or vascularized fibular transposition. 22 cases were the traumatic segmental loss and 7 cases were infected ones and 5 cases were the loss following tumor resection. Vascularized fibular graft was performed in 19 cases and vascularized fibular transposition was performed in 15 cases. The 33 cases(97%) of 34 cases had obtained sound bony union and average union time had been 18.6 weeks. Even local infection in the bone, vascularized fibular graft or transposition can be performed. Grafted or transposed fibula had been hypertrophied about 1.2 times in anteroposterior and lateral film which had been measured in the center of the fibula. The most common complication was the clawing of first or second toe. If the ipsilateral fibula is intact, the vascularized fibular transposition is better and if not, vascularized fibular graft is preferred. Operation using the vascularized fibula is a excellent method for the restoration of large bone defect in long bone.