Biological Reconstruction of Large Bone Defects with Vascularized Fibular Autograft
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Published:
Dec 20, 2023
Keywords:
Autograft, free tissue flap, reconstruction, bone defect
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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.
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.
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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
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Clinical Research
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References
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5. 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
6. 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
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8. 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
9. 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
10. 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
11. 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
12. 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
13. 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
14. 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
15. 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
16. 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
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
3. 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
4. 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
5. 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
6. 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
7. 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
8. 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
9. 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
10. 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
11. 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
12. 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
13. 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
14. 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
15. 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
16. 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