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Review
. 2023 Jan-Apr;18(1):44-50.
doi: 10.5005/jp-journals-10080-1575.

Free Fibula Flap in Traumatic Femoral Bone Reconstruction: A 10-year Review

Sebastien Viaud-Ambrosino  1 , Jean-Baptiste de Villeneuve Bargemon  1 , Najib Kachouh  1 , Andre Gay  1 , Alice Mayoly  1 , Regis Legre  1 , Charlotte Jaloux  1 , Caroline Curvale  1
Affiliations
Review

Free Fibula Flap in Traumatic Femoral Bone Reconstruction: A 10-year Review

Sebastien Viaud-Ambrosino et al. Strategies Trauma Limb Reconstr. 2023 Jan-Apr.

Abstract

Introduction: The loss of femoral bone substance represents a major therapeutic issue. When the loss of bone substance is extensive, or the local condition is unfavourable, there are few satisfactory solutions. In this study, we share our experience of large femoral bone reconstruction by free fibula flap.

Materials and methods: A retrospective monocentric chart review (2007-2017) was performed for 26 patients after receiving a pure bone-free fibula flap operation. The times of consolidation and hypertrophy of the graft were analysed according to the fixation with a 2-year follow-up.

Results: The time to consolidation was 8.7 months (range, 6-15) for double plates, 7.2 months (range, 5-11) for locked plates, 6 months (range, 5-7) for external fixators and plate blades and 8 months (range, 7-9) for intramedullary nails.Full weight-bearing was resumed at an average of 6.5 months (range, 5-10) postoperatively. It was authorised at 7 months (range, 5-10) for patients fixed by double plate, at 6.3 months (range, 5-9) for those fixed by a locked plate, at 5.5 months (range, 5-6) for those fixed by an external fixator or plate blade and at 7 months for those fixed by an intramedullary nail.

Conclusion: Free fibula flap remains reliable in the face of a great loss of bone material after trauma, with high consolidation rates. The choice of fixation must be reasoned and should offer a compromise between stability, allowing consolidation and hypertrophy of the graft, and rigidity, exposing the risk of massive osteosynthesis dismantling. Other multicentric studies, including more patients, should be carried out to compare the techniques of fixation.

How to cite this article: Viaud-Ambrosino S, Bargemon JBV, Kachouh N, et al. Free Fibula Flap in Traumatic Femoral Bone Reconstruction: A 10-year Review. Strategies Trauma Limb Reconstr 2023;18(1):44-50.

Keywords: Bone reconstruction; Femoral reconstruction; Free fibula flap; Loss of bone substance.

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Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Fig. 1
Fig. 1
de Boer and Wood formula, taken over by El-Gammal: Percentage of hypertrophy = (B2/A2–B1/A1)/(B1/A1) B2 corresponds to the diameter of the fibula at a time t of reconstruction by a free fibula (in millimetres). A2 corresponds to the diameter of the recipient femur at a time t of reconstruction by a free fibula (in millimeters). B1 corresponds to the diameter of the fibula transferred immediately postoperatively (in millimetres). A1 corresponds to the diameter of the recipient femur immediately postoperatively (in millimetres)
Figs 2A and B
Figs 2A and B
Hypertrophy, consolidation and weight-bearing resumption depending on the type of bone fixation
See this image and copyright information in PMC

References

    1. Taylor GI, Miller GDH, Ham FJ. The free vascularized bone graft: A clinical extension of microvascular techniques. Plastic Reconstr Surg. 1975;55(5):533–544. doi: 10.1097/00006534-197505000-00002. - DOI - PubMed
    1. Lhowe DW, Hansen ST. Immediate nailing of open fractures of the femoral shaft. J Bone Joint Surg Am. 1988;70(6):812–820. 3292534 - PubMed
    1. Judet H, Gilbert A, Mathoulin C, et al. Reconstruction of loss of bony substance in limbs by free vascularized fibula transplant. Chirurgie. 1991;117(5–6):469–476. 1817847 - PubMed
    1. Mathoulin C, Gilbert A, Judet H, et al. Free transfer of the vascularized fibula in pseudarthrosis and femoral bone loss. Rev Chir Orthop Reparatrice Appar Mot. 1993;79(6):492–499. 8066301 - PubMed
    1. Wood MB. Free vascularized fibular grafting—25 years’ experience: Tips, techniques, and pearls. Orthop Clin North Am. 2007;38(1):1–12. doi: 10.1016/j.ocl.2006.10.007. - DOI - PubMed

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