Vascularized fibula grafts: Clinical applications

The reconstruction of large skeletal defects has posed a challenging problem to the orthopedic surgeon.Such defects may be a result of trauma,infection,tumor resection,or reconstruction of congenital differences.Moore,Weiland,and Daniel have shown that for skeletal defects less than 6 cm, conventional cortical or cancellous bone grafts may prove satisfactory (1).However,for larger defects, or in a poorly vascularized tissue bed,conventional bone grafting results in an unacceptably high rate of complications.These include fatigue fracture,failure of incorporation,and nonunion (1).Such complications often lead to multiple surgical procedures and the need for prolonged immobilization.To prevent such complications,Moore et al.(1)and others (2-5)have recommend employing a microvascular bone transfer when reconstructing skeletal defects greater than approximately 6 cm in length, or in poorly vascularized tissue beds.