The short pedicle can be made longer by dissecting it free of the proximal fibula, and using the distal bone for the reconstruction. It also covers the applied anatomy, indications, operative techniques. Modified surgical techniques of free vascularized fibular. Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head. Of these options, free vascularized fibular graft fvfg is the treatment of choice for its structural and vascular support within the femoral head. The mean length of bone defects in the group of ilizarov technique was 6.
The vessels in the fibula graft are then microsurgically anastamosed to donor vessels at the hip. This report aimed to present the clinical results of the use of a modified surgical technique of fvfg for treatment of onfh. 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. Vascularized fibular grafting for the treatment of congenital pseudarthrosis of the tibia. An elective microsurgical procedure, free vascularized fibular grafting is an option for hip joint preservation. In the practice of orthopedics, bone grafting is a common procedure used to. Fvfgs also have a role in the treatment of avascular necrosis avn of the femoral head, failed spinal fusions and complex arthrodeses. The incision is approximately 1015 cm in length and is directed convex anterior. Technique of vascularized fibular grafting for femoral head osteonecrosis. This has been reported to occur on average 18 months after surgery. One disadvantage of the free fibula graft is the height discrepancy between the native mandible and the transplanted fibula, especially at the anterior segment.
Fibula osteocutaneous free flap dissection surgical video. Free vascularised fibular bone grafts fvfgs have proven to be. Skeletal reconstruction with a free vascularized fibular graft associated to bone allograft after. The necrotic area is debrided and cancellous graft placed in the periphery of the defect. Reconstruction of intercalary bone defect after resection of. Ceruso m, falcone c, innocenti m, delcroix l, capanna r, manfrini m. A comparison of the merits of free rib versus free fibular transfers. We report a technique with little interference to the surrounding soft tissues to harvest more than onethird of whole length. Free fibula by dr gunjan agrawal dr gunjan agrawal.
Of the multiple osseous donor sites, the free vascularized fibular graft fvfg has become the most commonly transferred vascular autograft for reconstructing segmental bone defects after trauma, nonunion, pseudarthrosis, osteonecrosis, and tumor resection 9, 10, 22, 24. In this case, we describe a novel modified technique used for distal tibia and. Results from a series of 407 cases article in microsurgery 338 june 20. Free vascularized fibular grafting yields extremely good results, particularly in precollapse. Our surgical expertise in avascular necrosis treatment, including free vascularized fibular grafting and hip preservation surgery, may minimize your need for joint replacement surgery in the future. The donor site morbidity of the free vascularized fibula graft is consistently acceptable among different studies, and is mostly avoidable with careful planning and appropriate technique 48,49,50.
The indications for the procedure and the operative technique are discussed. Thank you for your interest in free vascularized fibular graft fvfg surgery at penn orthopaedics. Treatment of osteonecrosis of the femoral head with free. Show full abstract without a skin paddle that were used for mandibular reconstruction is presented. According to the ficat classification, at the time of surgery, 17 hips were in grade 2 and 9 hips were in grade 3. Pdf reconstruction of mandibular defect by free re. Due to accurate preoperative imaging techniques, early diagnosis. Background the use of free vascularized fibular graft fvfg for. Vascularized fibular grafts in patients with avascular necrosis of femoral head. Surgical technique wheeless textbook of orthopaedics. Free vascularised fibular bone grafts fvfgs have proven to be extremely effective in managing larger defects longer than 6 cm where other conventional grafts have failed. Microsurgical vascularized fibular grafts for avascular necrosis of. Large bone defect, free vascularized fibular graft fvfg, ilizarov external fixator, compressiondistraction.
Free vascularized fibular graft fvfg was firstly reported in 1977 by. The reliability of the skin paddle harvested with the fibula flap. Free vascularized fibular grafting for the treatment of postcollapse. Modified surgical techniques of free vascularized fibular grafting for treatment of the osteonecrosis of femoral head. Patients with postcollapse, predegenerative osteonecrosis of the femoral head appear to benefit from free vascularized fibular grafting, with good overall survival of the joint, and significant. Free vascularized fibular graft reconstruction of large. Free vascularized fibula graft for avascular necrosis. This booklet provides a wealth of information about fvfg, a microsurgical procedure pioneered in the 1970s by dr. Free vascularized fibular graft for distal tibial and ankle arthrodesis. Free vascularised fibular grafts in orthopaedics ncbi.
Bone grafts are commonly used in all specialties of ortho paedic surgery, and an understanding of the principles and techniques of bone grafting is critical to the. Fibula osteocutaneous free flap dissection video youtube. In treating congenital pseudarthrosis of the tibia it is difficult to obtain initial bone healing, and. Improved technique has led to complication rates, including donorsite morbidity, statistically similar to that of nonvascular fibular grafts. The hip is approached through a curvilinear incision over the lateral aspect of the affected hip. Surgeons have the option of harvesting both fibulas to cover a single defect. Vascularized fibular grafting for the treatment of. I am proud now to bring this exacting and intricate surgical technique to. Microsurgical vascularized fibular grafts for avascular. Mandibular reconstruction using the free vascularized.
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