gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Article

Send article

Reconstruction of Long Tibia Bone Defect using Free Vascularized Fibula Graft and Locking Plate

Meeting Abstract

Search Medline for

  • presenting/speaker Yeun Soo Kim - Seoul National University College of Medicine, Seoul, South Korea
  • Young Ho Lee - Seoul National University College of Medicine, Seoul, South Korea
  • Hyun Sik Seok - Seoul National University College of Medicine, Seoul, South Korea
  • Min Ho Lee - Seoul National University College of Medicine, Seoul, South Korea
  • Yo Han Lee - Seoul National University College of Medicine, Seoul, South Korea
  • Che Ho Lee - Seoul National University College of Medicine, Seoul, South Korea
  • Young Ju Chae - Seoul National University College of Medicine, Seoul, South Korea
  • Goo Hyun Baek - Seoul National University College of Medicine, Seoul, South Korea

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1409

doi: 10.3205/19ifssh1045, urn:nbn:de:0183-19ifssh10459

Published: February 6, 2020

© 2020 Kim et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objectives/Interrogation: Recent advances in multimodality treatment with chemotherapy and wide surgical resection margins have improved the prognosis of patients with musculoskeletal sarcoma. Following wide resection of the tumor, several reconstructive procedures have been applied for large bony defects, including mega-prosthesis implantation, as well as allograft and vascularized bone grafts.

The reconstruction of tibia defects following tumor resection remains a surgical challenge. Our group aimed to achieve biological reconstruction with living bone autografts. Free vascularized fibular graft (VFG) has become an established procedure for the treatment of massive bone defects. Bone defect of the tibia is reconstructed by various methods. Bone transport or free vascularized fibula graft are selected for the defect. We are to report the clinical outcome for the bone defect more than 15-cm long using free vascularized fibular graft.

Methods: We analyzed retrospectively 14 patients who sustained long tibia defect more than 15-cm long and underwent free vascularized fibular graft from contralateral side. Average follow-up period was 5 year and average age of the patients was 28 year-old. Operation was performed as following: free vascularized fibular graft was harvested from contralateral side and inset inlay method. Overlapped portion of the graft was fixated with locking plate and screw. The tibia-fibular graft construct was stabilized with long locking plate. The artery of the graft pedicled was anastomosed to the anterior tibial artery with end-to-side method, but veins were in end-to-end methods.

Graft survival was evaluated by bone scan in all cases. Bony union and hypertrophic changes of VFG and the occurrence of stress fractures were confirmed by plain radiographs obtained monthly for one year after surgery. Functional recovery was evaluated at final follow-up using the system proposed by the Musculoskeletal Tumor Society (MTS).

Results and Conclusions: All graft survival was confirmed with the bone scan. All patients obtained bone unions between the host bone and fibular graft. There were 3 metal failures of the locking plates, but implant changes with longer plate could induce the bone union.

Free vascularized fibula graft with locking plate could be considered as a reliable and safe method for the long tibia bone defect.