Site Map

Bone loss reconstruction I: Vascularized fibula transfer

| Share

The loss of large bone fragments or parts may occur due to different reasons, but it is often caused by resection-removal of a malignant tumor, infection or after severe fractures (Figure 4A).
The advantage of transferring a vascularized bone is that it binds at the same speed of normal bone, as a fracture would (Fig. 4B-C). Furthermore, its size adapts to the needs of the load. For instance, a vascularized fibula placed on the tibia will grow until it is capable of withstanding the necessary loads of the limb (Fig 1D).
 

CMI

Figure 4A.11 year old patient, suffering treatment sequelae of a malignant tumor located in the left ulna. After surgical removal of the tumor, at age 8, a non-vascularized fibula was inserted, but it did not integrate correctly. Patient suffered several fractures, using plates and screws as an attempt to treat them. Therefore, the patient had to wear a brace in order to protect the forearm. The ulna presents a non-union or pseudoarthrosis, which cannot be solved with the use of conventional techniques due to it being non-vascularized. The best treatment option is the microsurgical reconstruction, by transplanting a vascularized fibula to replace most of the ulna, thus maintaining the movements of the elbow and forearm rotation.
 

CMI

Figure 4B. The vascularized fibula has integrated successfully and will help restore the function of the forearm.
 

CMI

Figure 4C.Movements of the elbow and forearm, restored. Since the microsurgical biological treatment is stable, the functionality obtained will be maintained throughout life.


Transfer of a vascularized fibula is the most commonly used technique for reconstructing large long bone defects. Technique is ideal when the cause is an infection or when long bones of the upper extremity are affected. At the lower extremity due to the large loads it supports, it is best to combine various surgical techniques. Otherwise, the child will not be able to perform normal load for months and will have to use crutches. A non biological nor microsurgical option is the replacement of bone by bone tissue bank (human cadaver donor) which is a devitalized bone preserved in a freezer (cryopreserved structural allograft) (Fig 5A-C). This technique leads to rapid bone stability, but since it has a low rate of integration, multiple complications normally arise in the future.

By combining both treatments, we are able to obtain stability (allograft) and biological capacity (vascularized bone flap) (Fig. 6). This procedure is called the Capanna technique.
 

CMI
 

Figure 5A. Cryopreserved femur segment obtained from a cadaveric donor (structural allograft bone). Its use to supplement bone defects allows immediate stability, but since is does not integrate correctly into the body, normal resistances are not reached (patient must use crutches or external orthoses). Multiple complications will arise in the future.

CMI

Figure 5B. MRI showing a malignant tumor (Ewing sarcoma) of the femur. Upon removal, the bone defect has to be reconstructed.

CMI

Figure 5C. Radiograph showing the replacement of 18 centimeters of femur removed, due to an Ewing's sarcoma, with a structural allograft. The whole is stabilized with intramedullary nail.

CMI

Figure 6. In this osteosarcoma (malignant bone tumor) of the femur, two techniques were combined after removal of 20 cm of femur. Structural allograft is used to provide initial stability until the vascularized fibula is integrated and enlarged. The assembly is stabilized with a plate.

Obstetric brachial palsy
Brachial Plexus Birth Palsy: Definition and Mechanisms of Injury:
Risk of brachial plexus birth palsy. Necessary diagnostic tests.
BPBP treatment: physical therapy and surgery
Shoulder problems in children with BPBP
Prevention and Risk of IRCS and DGH
Diagnosis and Treatment of Shoulder Dysplasia
What doctor does my baby need?
Clinical experience of Dr Soldado
Malformations
Short or absent thumb: thumb hypoplasia
Deviated wrist: radial and ulnar clubhand
Short fingers: Brachydactyly, symbrachydactyly, amniotic band syndrome
Less fingers: cleft hand and ulnar clubhand
Extra fingers or thumb: Polydactyly
Glued fingers or syndactyly
Cerebral Palsy
Definition, overview and assessment of cerebral palsy
Upper extremity problems in children with spastic hemiparesis
Nonsurgical treatment of spastic hemiparesis
The upper extremity in cerebral palsy with spastic tetraparesis
Surgical treatment of spastic hemiparesis
Microsurgery
Pediatric vascular microsurgery: overview
Bone loss reconstruction I: Vascularized fibula transfer
Bone loss reconstruction II: Periosteum transfer of vascularized fibula
Bone recalcitrant nonunion or pseudoarthrosis
Bone revascularization (osteonecrosis, aseptic necrosis)
Joint reconstruction. Transfer of epiphysis and growth plate of the vascularized fibula
Reimplantation and revascularization
Functional muscle transfer (vascularized and innervated)
Skin loss coverage
Fractures/Injuries
Overview of fractures
Typical bone fractures in children
Treatment of fractures in children: overview
Classification and treatment of physeal fractures
Fractures of the shoulder girdle, shoulder and arm of the child
Elbow fractures of the child
Fractures of the forearm and wrist of the child
Hand fractures in children
Upper extremity injuries of the child
Francisco Soldado
Doctor Francisco Soldado Videos
CV
Publications
Research Support
Known cases like yours
Cooperación internacional: Misiones quirúrgicas
Medical Links
© 2001-2015 Francisco SoldadoPrivacy PolicyLegal NoticeQuality Policy Website by