Reconstruction of Large Bone Defects and Complex Non-Unions Using a Free Fibular Bone Graft and a Supplementary Allograft

Abstract

Large bone defects or complex pseudarthrosis represent an interdisciplinary challenge. Established surgical procedures include autogenous cancellous bone graft, the Masquelet technique or bone transfer via segment transport as well as free microvascular bone transplantation. However, the successful use of all these techniques requires a specialized center with great interdisciplinary expertise. In the following case series we describe the technique of free fibula transplantation and additional allograft. In both cases a good functional result with full mechanical strength of the affected extremity and satisfactory patient comfort has been achieved. In the second case, implant failure with the necessity of revision endoprosthetics occurred during the procedure.

Key words

free fibular transplantation - femoral allograft - reconstruction of bone defects - pseudarthrosis

• References/Literatur

• 1 Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg 1975; 55: 533-544 doi:10.1097/00006534-197505000-00002
• 2 Beris AE, Lykissas MG, Korompilias AV. et al. Vascularized fibula transfer for lower limb reconstruction. Microsurgery 2011; 31: 205-211 doi:10.1002/micr.20841
• 3 Manoylovic R, Cheng JC, Levinsohn DG. et al. Free vascularized fibula transfer in the management of congenital pseudarthrosis of the tibia. Microsurgery 1991; 12: 170-174 doi:10.1002/micr.1920120306
• 4 Lenze U, Pohlig F, Knebel C. et al. Die autologe Fibulatransplantation zur Rekonstruktion knöcherner Defekte. Orthopäde 2017; 46: 648-655 doi:10.1007/s00132-017-3442-2
• 5 Capanna R, Bufalini C, Campanacci M. A new technique for reconstructions of large metadiaphyseal bone defects. Orthop Traumatol 1993; 2: 159-177 doi:10.1007/BF02620523
• 6 Krappinger D, Lindtner RA, Zegg M. et al. Die Masquelet-Technik zur Behandlung großer dia- und metaphysärer Knochendefekte. Oper Orthop Traumatol 2015; 27: 357-368 doi:10.1007/s00064-014-0300-9
• 7 Masquelet AC, Fitoussi F, Bégué T. et al. Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Plast Esthet 2000; 45: 346-353
• 8 Friedrich JB, Moran SL, Bishop AT. et al. Free vascularized fibula grafts for salvage of failed oncologic long bone reconstruction and pathologic fractures. Microsurgery 2009; 29: 385-392 doi:10.1002/micr.20624
• 9 Houdek MT, Rose PS, Milbrandt TA. et al. Comparison of pediatric intercalary allograft reconstructions with and without a free vascularized fibula. Plast Reconstr Surg 2018; 142: 1065-1071 doi:10.1097/PRS.0000000000004794
• 10 Moran SL, Shin AY, Bishop AT. The use of massive bone allograft with intramedullary free fibular flap for limb salvage in a pediatric and adolescent population. Plast Reconstr Surg 2006; 118: 413-419 doi:10.1097/01.prs.0000227682.71527.2b
• 11 Campanacci DA, Totti F, Puccini S. et al. Intercalary reconstruction of femur after tumour resection: is a vascularized fibular autograft plus allograft a long-lasting solution?. Bone Joint J 2018; 100-B: 378-386 doi:10.1302/0301-620X.100B3.BJJ-2017-0283.R2
• 12 Capanna R, Campanacci DA, Belot N. et al. A new reconstructive technique for intercalary defects of long bones: the association of massive allograft with vascularized fibular autograft. Long-term results and comparison with alternative techniques. Orthop Clin North Am 2007; 38: 51-60 doi:10.1016/j.ocl.2006.10.008