Clinical Study Of Vascularized Fibular Graft For Repair Of Large Segmental Bone Defects In Extremities

BackgroundHigh-energy trauma,infection,congenital bone disease and tumor resection often result in large segmental bone defects. Amputation was often used to treat these diseases in the past. However, as medical technology develops and the expectation of limb salvage increase in patients,. surgical methods are adopted to repair large segmental bone defects so as to retain the body and its functions at present. But the repair of large segmental bone defects in the limbs not only needs lots of bone, but also should attend the function of the limbs repaired. So large segmental bone defect repair and functional reconstruction has been the orthopedic problems and research focus . The common clinical methods for repairing the large segmental bone defects in extremities at present are as follow: autologous bone transplant,allogeneic bone transplant,Compressed and extended technology with external fixation. But each method has its limitations. Strach repaired tibial bone defects with fibular graft in 1967. Taylor used vascularized fibular transplantation for the treatment of a tibial large bone defect in the clinical for the first time in 1975. After that vascularized fibula transplantation had been widely used and achieved significant effects [3]. Different from traditional bone graft, Vascularized bone graft ensure the main blood supply to bone after transplantation . So most of these bone cells are survived .It is similar to the process of fracture healing . vascularized fibula graft has obvious advantages:①The vascularized fibula healed more quickly with the host bone;②The fibula would hypertrophy significantly afte transplantation;③The vascularized fibula can quickly adapt to the mechanical environment of the host bone;④Because of Independent blood supply,the fibula Can easily survive even in infective or Poor blood supply environment;⑤The vascularized fibula can repair a large bone defect at the early stage. Zhong-He Xu designed vascularized monitoring flap—fibular transplation to montior the blood supply of the fibula,which can increase the safety factor of fibular graft. Comparing with other methods,Bing-Fang Zeng believed that this method was more reliable,expected, and faster.ObjectiveTo explore the clinical effects of vascularized fibular graft for repairing large segmental bone defects in extremities.MethodsFrom January 2002 to January 2008,We selected 28 cases which were non-malignant and followed up for more than 20 months from 59 cases used fibula graft for repair large bone defects in Our hospitals. The Position of bone defect were femur,tibia,ulna,radius.The reasons of bone defect were trauma,trauma with osteomyelitis,bone tumors,congenital pseudoarthrosis. Vascularized fibula bone graft were used to repair the bone defects after removing the lesions . If cases combined with soft tissue defect, fibula flap or anterolateral thigh flap were adopted.ResultsAll patients were followed up for 20 months -6years (mean 28 months).The recipient bones got bone healing 3-8months after fibula bone graft operations. the fibula diameter enlargement near to recipient bone diameter 10-22 months(mean 17 months )after operation. Evaluate limb function by using Enneking system: tibia large bone defects cases got an average score of 24.2 points and Lower limb function recoveryed 80.67%.Patients'satisfaction was 94.1%.Femur large bone defects cases got an average score of 26.3 points and Lower limb function recoveryed 87.7%.Patients'satisfaction was 100% .radius and ulna tibia large bone defects cases got an average score of 21.75 points and wrist function recoveryed 72.5%.Patients'satisfaction was 100%.ConclusionThe method that vascularized fibular graft for repairing large segmental bone defects in extremities can effectively promote bone healing and reduce disability,infection,amputation rate.It is an effective way.