Biological Reconstruction of Large Bone Defects with Vascularized Fibular Autograft

DOI: https://doi.org/10.15417/issn.1852-7434.2023.88.6.1591
Keywords: Autograft, free tissue flap, reconstruction, bone defect

Abstract

Background: Given its biological and structural qualities, vascular fibular autograft is a good option for the reconstruction of large defects in long bones. Materials and Methods: A descriptive and retrospective observational study was conducted. We included all cases of patients who underwent surgery in our hospital between January 1, 2014, and January 1, 2021, and who had a vascular fibula autograft either standalone or in combination with a structural graft (Capanna technique). Results: There were 26 documented vascular fibula autograft procedures. Eight of the procedures involved the reconstruction of a long bone defect. The bone defect was an average of 7.7 cm in length. In five of the cases, the origin of the bone defect was post-traumatic, and in the remaining cases, it was tumoral. In all cases, complete consolidation was achieved. Surgical procedures performed on the lower extremities yielded better clinical and functional outcomes. Conclusions: Vascular fibula autograft either on its own or in combination with a structural graft, as described in the Capanna technique, is an excellent alternative for the reconstruction of bone defects ≥ 5 cm. Radiological, clinical and functional outcomes are good, with an acceptable rate of complications.

Downloads

Download data is not yet available.

Author Biographies

Pablo Jover Carbonell, Orthopedic Surgery and Traumatology Service, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
Orthopedic Surgery and Traumatology Service, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
Víctor Manuel Zarzuela Sánchez, Orthopedic Surgery and Traumatology Service, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
Orthopedic Surgery and Traumatology Service, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
Severiano Marín Bertolín, Plastic and Reconstructive Surgery Service, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
Plastic and Reconstructive Surgery Service, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
Vicente Marquina Moraleda, Orthopedic Surgery and Traumatology Service, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
Orthopedic Surgery and Traumatology Service, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
Guillermo Martínez Bovaira, Orthopedic Surgery and Traumatology Service, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
Orthopedic Surgery and Traumatology Service, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
Laura Castillo Ruipérez, Orthopedic Surgery and Traumatology Service, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
Orthopedic Surgery and Traumatology Service, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
Lorenzo Hernández Ferrando, Orthopedic Surgery and Traumatology Service, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
Orthopedic Surgery and Traumatology Service, Consorcio Hospital General Universitario de Valencia, Valencia, Spain

References

Gilbert A. Vascularised transfer of the fibula shaft. Int J Microsurg 1979;1:100-2.

Sepúlveda S, Carolis FV, Andrades CP, Benítez SS, Danilla ES, Eranzo CC. Reconstrucción con colgajos libres: experiencia de 33 años. Rev Chil Cir 2013;65(6):502-8. https://doi.org/10.4067/S0718-40262013000600005

de la Parra-Márquez M, Zorola-Tellez O, Cárdenas-Rodríguez S, Rangel-Flores JM, Sánchez-Terrones G.

Versatilidad del colgajo microvascular de peroné en reconstrucción de extremidades. Cir Cir 2016;84(3):213-9. https://doi.org/10.1016/j.circir.2015.08.004

Houben RH, Rots M, van den Heuvel SCM, Winters HAH. Combined massive allograft and intramedullary vascularized fibula as the primary reconstruction method for segmental bone loss in the lower extremity: A systematic review and meta-analysis. JBJS Rev 2019;7(8):e2. https://doi.org/10.2106/JBJS.RVW.18.00166

Tang CH. Reconstruction of the bones and joints of the upper extremity by vascularized free fibular graft: report of 46 cases. J Reconstr Microsurg 1992;8(4):285-92. https://doi.org/10.1055/s-2007-1006709

Capanna R, Campanacci DA, Belot N, Beltrami G, Manfrini M, Innocenti M, et al. A new reconstructive technique for intercalary defects of long bones: the association of massive allograft with vascularized fibular autograft. Longterm results and comparison with alternative techniques. Orthop Clin North Am 2007;38(1):51-60, vi. https://doi.org/10.1016/j.ocl.2006.10.008

Masquelet AC, Begue T. The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am 2010;41(1):27-37; table of contents. https://doi.org/10.1016/j.ocl.2009.07.011

Kalra GS, Goel P, Kumar SP. Reconstruction of post-traumatic long bone defect with vascularised free fibula: A series of 28 cases. Indian J Plast Surg 2013;46(3):543-8. https://doi.org/10.4103/0970-0358.122013

DeCoster TA, Gehlert RJ, Mikola EA, Pirela-Cruz MA. Management of posttraumatic segmental bone defects. J Am Acad Orthop Surg 2004;12(1):28-38. https://doi.org/10.5435/00124635-200401000-00005

Zekry KM, Yamamoto N, Hayashi K, Takeuchi A, Alkhooly AZA, Abd-Elfattah AS, et al. Reconstruction

of intercalary bone defect after resection of malignant bone tumor. J Orthop Surg (Hong Kong) 2019;27(1):2309499019832970. https://doi.org/10.1177/2309499019832970

Aktuglu K, Erol K, Vahabi A. Ilizarov bone transport and treatment of critical-sized tibial bone defects: a narrative review. J Orthop Traumatol 2019;20(1):22. https://doi.org/10.1186/s10195-019-0527-1

Jeys LM, Kulkarni A, Grimer RJ, Carter SR, Tillman RM, Abudu A. Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis. J Bone Joint Surg Am 2008;90(6):1265-71. https://doi.org/10.2106/JBJS.F.01324

Landau MJ, Badash I, Yin C, Alluri RK, Patel KM. Free vascularized fibula grafting in the operative treatment of malignant bone tumors of the upper extremity: A systematic review of outcomes and complications. J Surg Oncol 2018;117(7):1432-9. https://doi.org/10.1002/jso.25032

Paulussen M, Ahrens S, Dunst J, Winkelmann W, Exner GU, Kotz R, et al. Localized Ewing tumor of bone: final results of the cooperative Ewing’s Sarcoma Study CESS 86. J Clin Oncol 2001;19(6):1818-29.

https://doi.org/10.1200/JCO.2001.19.6.1818

Liu S, Tao S, Tan J, Hu X, Liu H, Li Z. Long-term follow-up of fibular graft for the reconstruction of bone defects. Medicine 2018;97(40):2605. https://doi.org//10.1097/md.0000000000012605

Greenwald S, Boden S, Goldberg V, Khan Y, Laurencin C. Bone-graft substitutes: facts, fictions, and applications. J Bone Joint Surg 2001;83-A Suppl 2 Pt 2:98-103. https://doi.org/10.2106/00004623-200100022-00007

Published
2023-12-20
How to Cite
Jover Carbonell, P., Zarzuela Sánchez, V. M., Marín Bertolín, S., Marquina Moraleda, V., Martínez Bovaira, G., Castillo Ruipérez, L., & Hernández Ferrando, L. (2023). Biological Reconstruction of Large Bone Defects with Vascularized Fibular Autograft. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(6), 620-629. https://doi.org/10.15417/issn.1852-7434.2023.88.6.1591
Issue
Vol 88 No 6 (2023)
Section
Clinical Research
Copyright (c) 2023 Revista de la Asociación Argentina de Ortopedia y Traumatología

Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.

In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.

It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.

The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.