Hand and Microsurgery & Orthopedics and Traumatology (EMOT) Hospital, 1418 Sok. No: 14 Kahramanlar, 35230 Izmir, Turkey.
Hand and Microsurgery & Orthopedics and Traumatology (EMOT) Hospital, 1418 Sok. No: 14 Kahramanlar, 35230 Izmir, Turkey.
Injury. 2021 Oct;52(10):2926-2934. doi: 10.1016/j.injury.2019.08.013. Epub 2019 Aug 14.
Large segmental bone defects due to major trauma constitute a major challenge for the orthopaedic surgeon, especially when combined with poor or lost soft tissue envelope. Vascularized fibular transfer is considered as the gold standard for the reconstruction of such defects of the extremities due to its predictable vascular pedicle, long cylindrical shape, and tendency to hypertrophy, and resistance to infection. Vascularized bone grafts remain viable throughout the healing period and are capable of inducing rapid graft union without prolonged creeping substitution, osteogenesis and hypertrophy at the reconstruction site, and fight with infection. The fibular graft can be transferred solely, or as a composite flap including muscle, subcutaneous tissue, skin and even a nerve segment in order to reconstruct both bone and soft tissue components of the injury at single stage operation. Such a reconstruction can even be performed in the presence of local infection, since vascularized bone and adjacent soft tissue components enhances the blood flow at the traumatized zone, allowing for the delivery of antibiotics and immune components to the infection site. In an effort to preserve growth potential in pediatric patients; the fibular head and proximal growth plate can be included to the graft. This practice also enables to reconstruct the articular ends of various bones, including distal radius and proximal ulna. Apart from defect reconstruction, vascularized fibular grafts also proved to be a reliable in treating atrophic nonunions, reconstruction of osteomyelitic bone segments. These grafts are superior to alternative reconstructive techniques, as bone grafts with intrinsic blood supply lead to higher success rates in reconstruction and accelerate the repair process at the injury site in cases where blood supply to the injury zone is defective, poor soft tissue envelope, and local infection at the trauma zone.
由于重大创伤导致的大段骨缺损对矫形外科医生来说是一个重大挑战，尤其是当伴有软组织覆盖不良或丢失时。带血管腓骨移植因其可预测的血管蒂、长圆柱形状、肥大倾向和抗感染能力，被认为是四肢此类缺损重建的金标准。带血管骨移植物在整个愈合过程中保持活力，并能够在没有长时间爬行替代、重建部位成骨和肥大以及与感染作斗争的情况下，快速诱导移植物愈合。腓骨移植物可以单独转移，也可以作为包括肌肉、皮下组织、皮肤甚至神经节段的复合皮瓣转移，以便在单次手术中重建损伤的骨和软组织成分。即使在存在局部感染的情况下，也可以进行这种重建，因为带血管的骨和相邻的软组织成分可以增加受伤区域的血流，从而将抗生素和免疫成分输送到感染部位。为了保护儿科患者的生长潜力，可以将腓骨头和近端生长板包含在移植物中。这种做法还可以重建各种骨骼的关节末端，包括桡骨远端和尺骨近端。除了缺损重建外，带血管腓骨移植还被证明是治疗萎缩性骨不连和骨髓炎骨段的可靠方法。这些移植物优于替代重建技术，因为具有内在血液供应的骨移植物在重建中具有更高的成功率，并在损伤区域的血液供应有缺陷、软组织覆盖不良和创伤区域局部感染的情况下加速损伤部位的修复过程。
