Surgical technique of modified free vascularized fibular. It often occurs in younger patients for whom the traditional treatment of shoulder arthroplasty is not optimal. When a long strut of bone is required, free fibula graft is used to repair the extremity. Moreover, with inadequate surgical technique, flapspecific complications can occur, such as loss of the skin paddle or inadequate pedicle length. The staff of the duke university orthopaedics wishes to provide efficient. Distal femur reconstruction with vascularized fibular graft. Discussion one of the option for surgical treatment for distal humerus osteosarcoma is limb salvage sugery with free vascularized fibular graft technique. Recent updates of surgical techniques and applications of. Free vascularized fibular grafting for the treatment of. The authors have utilized free vascularized fibular grafts fvfgs for reconstruction of the spine following tes. We presented this novel technique of bone grafting for distal tibial defect, aiming to serve as an alternative option for the orthopaedic surgeon.
Hemifibular grafting for metacarpal giant cell tumor. This report aimed to present the clinical results of the use of a modified surgical technique of fvfg for treatment of onfh. Pertinent pearls on using fibular autograft with ex fix for. This paper describes a technique of arthroscopically assisted fibular strut grafting for avascular necrosis of the humerus. Choosing the surgical technique is a complex decision to be taken by a. Modified surgical techniques of free vascularized fibular.
Biomechanical analysis of fibular graft techniques for. Part of the practical, highly illustrated operative techniques series, this fully revised title by drs. Epiphyseal fibula transfer to proximal humerus following. Oct 12, 2020 the first description of a free fibular graft transport was made by taylor et al in 1975. All patients underwent surgery by the same surgical team with experience in microsurgery. Fibular strut graft augmentation for open reduction and. Techniques in hip arthroscopy and joint preservation surgery. The disadvantages are slow incorporation and harvest site complications.
Nov 01, 2010 in conclusion, transfibular ankle arthrodesis with fibular onlay strut graft is an effective technique for ankle fusion in the highrisk patient population. As an alternative to ctt, the modified light bulb technique lbt has been reported to have a higher. The purpose of this article is to describe the surgical technique for vascularized reconstruction of defects after tes. Ipsilateral fibular transport using ilizarovtaylor spatial frame for a limb salvage reconstruction. It also highlights tips and pearls of surgical technique in some crucial steps of harvesting the vascularized fibular graft in order to offer a vascularized bone with safety and low donor site morbidity. Penn orthopaedics is currently the only medical center in the region offering free vascularized fibular graft surgery and other complex microsurgical operations. On average the surgical procedure lasted 232 minutes median 115 minutes. In two cases, the vascularized fibular graft included the proximal fibular epiphysis to reconstruct the druj and ulnocarpal joints. The free vascularized fibular grafting fvfg has been shown to support the subchondral architecture as well as restore local circulation for the necrotic femoral head in treatment of onfh. In its early stages, free vascularized fibular grafting of the femoral head required two teams of surgeons and an operative time of six hours or more. The conventional technique of free nonvascularized fibular grafting is attended.
Avascular necrosis is a relatively common entity that affects the proximal humerus and can lead to. Of these options, free vascularized fibular graft fvfg is the treatment of choice for its structural and vascular support within the femoral head. Campanacci and zanoli 5 described a fibula pro tibia technique with fibular 18 fixation to the pseudarthrosis site. The vascularized fibula flap was first described in 1975 by taylor and colleagues. Detailed preoperative planning, experience in microvascular techniques, and careful postoperative followup are necessary to minimize complications and improve outcome. The hypothesis was that the use of fibular strut allografts in. The original scientific article in which the surgical technique was presented was published in jbjs vol. Improved technique has led to complication rates, including donorsite morbidity, statistically similar to that of nonvascular fibular grafts. Threephase bone imaging was undertaken to monitor the viability of vascularized bone grafts after surgery. The graft host junctions were augmented with autologous cancellous bone grafts at primary surgery in one patient, while eleven patients had no additional bone grafting. A modified bohlman technique using a novel implant for treatment of. The technique we have described is a systematic and reliable way to perform an ankle arthrodesis with excellent anatomic placement of screw fixation, preservation of the subtalar joints, and resistance to potentially disruptive forces in all planes. Proximal tibial reconstruction with auto transplantation of. The use of autologous free vascularized fibula grafts in reconstruction of the mobile spine following tumor resection.
Ankle arthrodesis and fixation by plate osteosynthesis. Our elearning platform contains high resolution images and a certified cme of the epiphyseal fibula transfer to proximal humerus following resection for osteosarcoma surgical procedure. It also covers the applied anatomy, indications, operative techniques. Under fluoroscopic guidance, check the correct insertion site and direction of the drilling. Arthroscopically assisted surgical decompression and fibular. From october 2000 to august 2004, 124 patients 9 hips with osteonecrosis of the femoral head were treated with modified free vascularized. Lower limb reconstructive surgery best reconstructive. In order to delay the progress of the disease, many surgical techniques have been described. Distal tibia, osteosarcoma, arthrodesis, vascularized fibular graft vfg. Free vascularised fibular grafts in orthopaedics ncbi nih. This book gathers authors from different continents, with different points of view and. Pfeffer, mark easley, beat hintermann, andrew sands, and alastair younger brings you up to speed with mustknow surgical techniques in todays foot and ankle surgery. The method is used in femoral metaphyseal defects combined with knee stiffness as safer procedure than free vascularized fibular graft. Free vascularized fibular grafts for reconstruction of.
Average age of the four patients at time of vascularized fibular grafting was 10 years range 316 years. Various techniques have been reported to treat bon. Measurements included graft width and thickness, distance reached from harvest level to the top of. Use of free vascularized fibular graft for congenital ulnar. Harvesting nonvascularized fibular graft from the contralateral limb, 2. Additionally, the outcomes of consecutive cases treated with this technique are reported. All surgical procedures for ccl instability begin with a thorough exploration of the stifle joint through a lateral parapatellar approach. This approach will increase the bone bridge between the atfl arm and cfl arm of the construct. Vascularised bone grafting requires surgical experience and equipment not readily available in every hospital. Bone grafting is in the field of interest of many surgical specialties, such as. Raising the osteocutaneous fibular flap offers excellent possibilities for oral reconstructive surgery but is associated with specific donorsite risks.
Fibula osteocutaneous flap ao foundation surgery reference. Vascularised fibular graft in the management of femoral head. Free vascularized fibular grafting has been reported to be successful for patients with early stages of osteonecrosis, but little is known about its efficacy after the femoral head has collapsed. Free vascularized fibular grafting improves vascularity. The vascularized fibular grafting technique appeared in 1975 3. Avascular necrosis is a relatively common entity that affects the proximal humerus and can lead to substantial morbidity. These include biceps tenodesis procedures,6, 7 bone block advancements,8 and reconstruction techniques based off the fibular head, using 19 or 2 femoral tunnels. For these patients, a doublebarrel fibula graft is divided into two types 23. Insert a 2mm drill through the tip of the distal fibula just anterior to the calcaneofibular ligament fig. The use of autologous free vascularized fibula grafts in. Proximal tibial reconstruction with auto transplantation. Oct 14, 2014 of these options, free vascularized fibular graft fvfg is the treatment of choice for its structural and vascular support within the femoral head. Intraarticular techniques use some sort of graft material to anatomically replace the cranial cruciate ligament.
Six cadaveric dissections were performed 2 included upper and all 6 included lower rib dissections. Vascularized fibular graft as a surgical option for. Implantsupported fixed and removable prostheses in the. Osteonecrosis of the femoral head, a disease primarily affecting young adults, is often associated with collapse of the articular surface and subsequent arthrosis.
Part of the practical highly illustrated operative techniques series this fully revised title by drs. However, it is technically challenging to direct the. We present an innovative surgical technique for the management of such bone defects. Proximal humerus fractures are common problems plaguing the elderly population. Background mandibular reconstruction of segmental defects caused by trauma or tumor excision is a challenge despite numerous advances in surgical and fixation techniques. Intercalary reconstructions with vascularised fibula and. Free fibula is harvested with a skin paddle and a soleus muscle located in the superficial posterior compartment of the leg from back of the knee to the ankle, and transferred to the targeted area of treatment for reconstructing the composite tissue. The shape of the incision may be curved or a straight line. Learn the epiphyseal fibula transfer to proximal humerus following resection for osteosarcoma surgical technique with step by step instructions on orthoracle. Stepbystep evidencebased guidance including numerous videos online walks you through new procedures and modifications. Free vascularised fibular graft, orthopaedics, bone defects.
An outline of the skin incision is then inscribed using a surgical marker. The use of a free fibular strut as a biological intramedull. Arthroscopically assisted surgical decompression and. Mar 21, 2012 there is a myriad of surgical techniques nowadays involving some kind of bone graft or bone graft substitute. In conclusion, transfibular ankle arthrodesis with fibular onlay strut graft is an effective technique for ankle fusion in the highrisk patient population. Anatomic posterolateral corner reconstruction using single. After induction chemotherapy, wide excision and reconstruction using free vascularized fibular graft followed with interpositional elbow arthroplasty technique was done. The main indications for this graft are defects larger than 5 to 6 cm or with poor vascularity of the surrounding soft tissues. Reconstructive arthrodesis using a nonliving fibular graft with an. Although several surgical methods for the management of humeral shaft nonunion have been examined in the literature such as compression. Pdf reconstruction after resection of the distal fibula for. Current concepts with autogenous bone grafting podiatry. Traditional repair techniques for the cranial cruciate.
In this study, nine patients underwent novel doublestrut fibula reconstruction after tumor resection of distal tibia, and achieved satisfactory result. Pertinent pearls on using fibular autograft with ex fix. Jan 01, 2015 of these options, free vascularized fibular graft fvfg is the treatment of choice for its structural and vascular support within the femoral head. Bone grafting is the surgical procedure in which new bone bone graft or a replacement material graft substitute, is placed into bone fractures or bone defects to aid in healing. We present a new surgical technique of bone reconstruction, based on the transposition of the ipsilateral fibula with. Ipsilateral fibular transport using ilizarovtaylor. The purposes of this study were to determine the outcomes of fibular strut allografts in treatment of proximal humerus fractures with open reduction internal fixation orif and to present the authors preferred surgical technique. Treatment of nonunions of the humeral shaft with nonvascularized. Four cases of congenital ulnar pseudarthrosis treated with free vascularized fibular graft are presented here. The authors devised a novel reconstructive surgical procedure that. Novel doublestrut fibula ankle arthrodesis for large tumor. It also highlights tips and pearls of surgical technique in some crucial steps of harvesting the vascularized fibular graft in order to offer a. Fibular grafts have the advantages of strength, length, and relative ease of harvest. Dec 12, 2017 verify the position and alignment of the fibular graft with multiple angles of fluoroscopic visualization to avoid formation stress risers or overt fracture.
The present manuscript updates several issues in application of free vascularized fibular graft in extremity and trunk reconstruction. Vascularized fibula transfer for lower limb reconstruction. Apr 20, 2016 introduction tumors of the proximal tibia, in children, can affect the growth plate and pose a challenge to further reconstruction of the bone defects resulting from tumor resection. Biomechanical analysis of various reconstructive methods for the. Minimally invasive harvesting of nonvascularized fibular graft in.
There was a significant relationship between the outcome of the grafting procedure and the etiology of the osteonecrosis p 0. Ranawat, and michael leunig provide a stepbystep, balanced approachwith contributions from an array of north american and international surgeonsto preoperative planning, surgical technique, technical pearls. The free vascularized fibular graft has been successfully applied as a. There is a myriad of surgical techniques nowadays involving some kind of bone graft or bone graft substitute. Campanacci and zanoli 5 describe d a fibula pro tibia technique with fibular fixation to the pseudarthrosis site. Novel doublestrut fibula ankle arthrodesis for large tumorrelated. The free vascularized fibular grafting was performed as described previously. Indications and surgical technique of distal femur reconstruction with vascularized fibular graft and fibular vessels pedicle are presented. Farlateral vascularized rib graft for cervical and lumbar s. Ankle fusion with centralisation of the fibula after. This study describes a novel technique for harvesting lateral rib grafts on an intercostal pedicle for use in cervical and lumbar posterolateral arthrodesis. Free vascularised fibular graft in multioperated patients for an. Stepbystep, evidencebased guidance, including numerous videos online, walks you through new procedures and.
Harvesting the nonvascularized autogenous fibular graft. At preadmission, a physical examination and lab tests were performed to ensure his wellbeing and preparedness for surgery. Chu, md,2 anuj patel, md,1 brett rosenthal, md,1 john h. Biomechanical evaluation of a novel hybrid reconstruction plate f. Posteriorly, a lateral dissection approach to the free fibula was published by gilbert, followed by chuang.
In the weeks before surgery, xrays and mris were performed to evaluate the extent of mr. Feb 04, 2015 allograft fibula is slower to incorporate than autologous iliac crest. To evaluate the surgical technique, clinical results, and the complications of modified free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head. Lubek, in maxillofacial surgery third edition, 2017 introduction. Arthroscopically assisted surgical decompression and fibular strut grafting for proximal humerus avascular necrosis. Introductionintroduction contemporary oral and maxillofacialcontemporary oral and maxillofacial surgeons need bone grafting techniques tosurgeons need bone grafting techniques to satisfy patient needs in trauma, pathology,satisfy pati. Aug 17, 2020 background free vascularized fibula graft fvfg techniques have most consistently demonstrated beneficial effects in young patients diagnosed with nontraumatic osteonecrosis of the femoral head nonfh, and the core track technique ctt in particular is the most commonly used technique. Jan 01, 2017 after induction chemotherapy, wide excision and reconstruction using free vascularized fibular graft followed with interpositional elbow arthroplasty technique was done. Decisionmaking for all reconstruction and surgical techniques. Novel doublestrut fibula ankle arthrodesis for large. Following resection, reconstruction techniques available include tricortical iliac grafting, vascularized or nonvascularized fibular grafting, or metatarsal grafting. The reconstruction of mandible defects using a free fibula graft was first described by hidalgo. Mandibular reconstruction with a readymade type and a. A twoteam approach is recommended, with one raising the fibular flap and the other.
Place hohmann retractors behind the medial edge of the fibula, thus reflecting the peroneal tendons posteriorly. Free vascularized fibular grafts for reconstruction of skele. Apr 20, 2018 a chose to have free vascularized fibular graft surgery. Techniques in hip arthroscopy and joint preservation surgery is a stunning visual guide to the latest developments in the field. Techniques and complications of bone graft harvesting.
When used in young patients with precollapse onfh, fvfg can greatly improve patient outcome, with lower rates of conversion to tha than other treatment modalities. The hypothesis was that the use of fibular strut allografts in treating proximal humerus fractures with orif will provide low reoperation rates with acceptable outcomes. Recent updates of surgical techniques and applications of free. Microsurgical vascularized fibular grafts for avascular. Fibular strut grafting to prevent humeral head collapse has been described as a viable treatment option. To reduce the operative time, preparation of the hip and harvesting of the fibular graft were performed concurrently by two teams. Reconstruction methods do not always compensate the potential for bone growth in this segment. Five different mandibular reconstruction surgical procedures were developed. Microsurgical anastomosis of the fibula bone plastic.
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