Effect of treatment of long femoral bone defect by combinatorial fibular graft with monitoring island skin flap on bone intensity and loaded walking ability

Qifeng GUO; Shifeng WEN; Zhonghe XU

ABSTRACT

BACKGROUND:

The effect of the treatment of long tubular bone defect by free vascularized fibular graft, especially when combined with monitoring island skin flap is definitely reliable. However, there is still the possibility of broken fibular graft with single fibular graft for repairing the long loading tubular bone.

OBJECTIVE:

To investigate the clinical effect on the treatment of long femoral bone defect by combinatorial fibular graft with monitoring island skin flap.

DESIGN:

Before and after self-controlled observation.

SETTING:

Department of Orthopaedic Spine Surgery, Guangzhou People's Hospital

PARTICIPANTS:

Totally 14 patients who wer treated for long femoral bone defect in the Department of Orthopaedic Spine Surgery were recruited between July 1995 and November 2003. Locus distal part of the femur,5cases; middle part of the femur, 9cases.The length of bone defect was 6 to 28 cm.

INTERVENTIONS:

There were 7 cases of free vascularized bi-fibular graft transplantation with monitoring island skin flap. There were 7 cases of free vascularized fibular graft centralized with large segmental allograft.Monitoring island skin flap was 3 cm×5 cm, sectioned fibular was 16 to 32cm. Dry frozen bone of allograft was 12 to 28 cm. The wound and island skin were detected postoperatively.MAIN OUTCOME

MEASURES:

The living condition of bi-fibular graft or binding composite allograft with skin flap, morphology change of transplanted bone and loaded walking ability in patients with bone defect after operation.

RESULTS:

Totally 14 patients entered the result analysis. Seven cases in bi- fibular group were followed up for 3 years and 7 patients in the centralized graft group were followed up for 1 year. Fourteen cases detected by monitoring island skin flap all survived. One case in the centralized graft group presented yellow exudates 3 months after operation, and then the graft bone was taken out. Follow-up of the rest 6 patients showed that transplanted fibular bone was closely connected with allograft. The thickness of the transplanted bone was increased, shaped and similar with the diameter of the femur at the receptor. Patients in the two groups could walk with loading without walking stick. Transplanted bone has no fracture.

CONCLUSION:

Transplantation of free vascularized bi-fibular graft transplant or free vascularized fibular graft monitoring island skin flap binding to large segmental allograft can increase its structural strength through hypertrophy, decrease or avoid fracture of the transplanted graft fibula.