Fibular grafts in global reconstructive surgery: a bibliometric analysis

Abstract

Background: Over the past few decades, fibular grafts have been widely utilized across 86 countries and regions globally for surgical reconstruction of various anatomical sites, including the mandible, upper extremities, lower extremities, spine, and in phalloplasty procedures. The present study aims to systematically investigate the developmental trajectory of fibular graft and identify research priorities for surgeons.

Methods: A bibliometric analysis was conducted by searching the Web of Science Core Collection on April 12, 2024, for articles published between 2004 and 2023 on fibular grafting, using the query TS = ("graft" OR "transfer" OR "flap") AND TS = ("fibular"). We included full-text English articles and reviews, and exclude documents that were not related to fibular grafting or were non-research-oriented publications. GraphPad Prism, CiteSpace, and VOSviewer analyzed publication trends and co-citation networks, providing insights into fibular grafting research.

Results: A total of 2,884 fibular graft publications were analyzed. Out of 86 countries/regions, the United States and China stood out as the main contributors in terms of publication volume, while England had the highest citation rate per publication. The journals with the most publications and citations were The Journal of Craniofacial Surgery and Plastic and Reconstructive Surgery, respectively. Mark K. Wax had the most publications, while Hidalgo DA had the highest co-citation count. The most frequently occurring keywords were "reconstruction" and "mandibular reconstruction." Co-citation reference clustering revealed a growing preference for vascularized fibular grafts over non-vascularized alternatives. The top 10 co-cited references were exclusively focused on mandibular reconstruction. Keyword bursts analysis showed that over the initial 20-year period, identified keywords fall into three main themes: graft design (e.g., osteoseptocutaneous flap, perforator flap), reconstruction areas (e.g., maxilla, extremity, ankle, spine and phalloplasty), and defect causes (e.g., pseudarthrosis, sarcoma, bone tumor). In particular, fibular grafts in phalloplasty represent an emerging trend among various anatomical reconstruction sites. In the last 5 years, there has been a notable rise in interest in 3D planning, virtual surgical planning, augmented reality, and reconstruction accuracy.

Conclusion: The findings offer an in-depth overview of the landscape of fibular graft research, highlighting key contributors and emerging trends.

Keywords: bibliometric study; fibular grafts; orthopedic surgery; reconstructive surgery; research trends.

Figure 1

The search strategy used for the present bibliometric analysis. Search of the Web of Science database was conducted with the following approach: ([TS = (graft)] OR TS = (flap)) OR TS = (transfer) AND TS = (fibula). Studies published between January 1, 2004, and December 31, 2023, were considered for inclusion. Out of the initially identified 3,165 studies, 177 were excluded due to being book chapters, corrections, or editorial material, while 144 studies were excluded because they were not written in English. Ultimately, 2,844 studies remained and were included in the subsequent analyses. TS, topic search.

Figure 2

Trends in the number of publications and analysis of country/regions in fibular graft-related research. (A) The annual worldwide publication output. (B) Growth trends in the publication output from the top 10 countries. (C) The annual publication output from the top 10 countries. (D) Cooperation network of countries/regions. Each node in the graph symbolizes a country or region, with its size reflecting the volume of publications originating from that particular area. The thickness of the connections between nodes indicates the intensity of collaboration between the respective countries or regions. The shade of the node correlates with the timeline of the country's or region's initial publication, with darker shades representing earlier publications. Nodes covered by purple circles denote high centrality within the network.

Figure 3

Analysis of journals and co-cited journals. (A) The density map of journals. (B) The dual-map overlay of journals related to fibular graft.

Figure 4

The visualization of cited authors on research of fibular graft.

Figure 5

Visualizing co-cited literatures on research of fibular graft, by showing clustering (A) and volcano diagram (B).

Figure 6

Top 50 references with the strongest citation bursts. A red bar indicates high citations in that year. The blue bars were references cited less frequently.

Figure 7

The visualization of keywords on research of fibular graft. (A) Network visualization of keywords in research on fibular graft mapped four distinct clusters consisting of nodes with the same color. (B) Term density map of keywords in the field of fibular graft in the WoSCC database. The heatmap illustrates the frequency of keywords through varying shades of color; vibrant red indicates high-frequency keyword, while cool blue represents low-frequency keywords. (C) The volcano plot showing timeline view of cluster analysis of keywords.

Figure 8

Top 50 keywords with the strongest citation bursts. A red bar indicates high citations in that year. The blue bars were references cited less frequently.