[Vascularized fibula transfer. A review].

The first vascularized fibula transfer was done by Ueba et al. (1983) in 1974 and has since become a standard technique for special indications in the English, French, Japanese and Chinese-world. Within the last 5 years this technique has received more and more attention in the German-speaking countries. The vascularized fibula transfer is successfully used to reconstruct segmental bone defects larger than 5 to 8 cm that are caused by trauma, tumor, pseudarthrosis or congenital defects. When used to treat osteomyelitis, the vascularized fibula transfer failed to fulfill expectations. Bone defects smaller than 10 cm can also be treated by vascularized iliac crest transfer. To achieve rapid healing, the following points must be followed carefully: when treating osteomyelitis, the infection must be healed--negative cultures and good granulation tissue--prior to bone transplantation. Application of systemic or local antibiotics and aggressive debridement of necrotic bone and soft tissue must be carried out until the cultures taken from the wound are negative. Soft tissue defects must be treated by soft tissue transfer in order to facilitate wound closure with well-vascularized tissue. Vascularized bone transfer should be the treatment of choice for the femur and upper extremities. Precise preoperative planning, especially in high-energy trauma cases, reduces the complication rate. Rigid internal fixation of the bone graft with the recipient site by a smaller proximal and distal plate or by a plate bridging the whole bone defect running parallel to the fibula graft leads to rapid healing without malalignment.(ABSTRACT TRUNCATED AT 250 WORDS)