Ou Qifeng, Wu Panfeng, Zhou Zhengbing, Pan Ding, Tang Ju-Yu
Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, No.87 XiangYa Road, Changsha, 410008, Hunan, China.
BMC Surg. 2020 Oct 2;20(1):216. doi: 10.1186/s12893-020-00875-9.
The success of free vascularized fibular bone graft (FVFBG) has accelerated the osteo reconstruction which results from trauma, resection of a tumor or an infectious bone segment, or correction of congenital deformity. But the complication behind should not be overlooked. The failure could necessitate a second surgery, which prolong the rehabilitation period and produce further health cost. Worst, the patients may suffer a permanent impaired ankle function, or a sustained morpho-functional loss on reconstructive area which are hard to save. To provide an overview of the complication related to reconstruction by FVFBG, a narrative review is conducted to identify the complications including their types and rates, the contributing factors, the approaches to measure and the techniques to avoid. Methodologically, by quick research on Pubmed and abstract reading of reviews, we characterize five reconstructive areas where FVFBG were most frequently applied: extremities, mandible, spine, osteonecrosis of femoral head, and penile. Following, the complications on different reconstructive areas are retrieved, studied and presented in five (or more specifically, six) separate sections. By the way, meaningful difference between FVFBG and other bone flap was presented in a few words if necessary. Donor-site morbidities were studied and summarized as a whole. In these literatures, the evidences documented on limb and mandibular reconstruction have the fullest detail, followed by the spine and lastly the penile. In conclusion, FVFBG, though a mature technique, needs further deep and comprehensive study and maybe device-based assistance to achieve better reconstructive effect and minimize donor-site damage.
游离带血管腓骨骨移植（FVFBG）的成功加速了因创伤、肿瘤切除、感染性骨段切除或先天性畸形矫正而导致的骨重建。但背后的并发症不应被忽视。手术失败可能需要二次手术，这会延长康复期并产生更多医疗费用。更糟糕的是，患者可能会永久性踝关节功能受损，或者重建区域出现持续性形态功能丧失，而这些很难挽回。为了概述与FVFBG重建相关的并发症，本文进行了一项叙述性综述，以确定并发症，包括其类型和发生率、促成因素、测量方法及避免技巧。在方法上，通过快速检索PubMed并阅读综述摘要，我们确定了FVFBG最常应用的五个重建区域：四肢、下颌骨、脊柱、股骨头坏死和阴茎。随后，在五个（或更具体地说，六个）单独的部分中检索、研究并呈现不同重建区域的并发症。顺便提及，如果有必要，简要介绍FVFBG与其他骨瓣之间的显著差异。对供区并发症进行整体研究和总结。在这些文献中，关于肢体和下颌骨重建的证据最为详细，其次是脊柱，最后是阴茎。总之，FVFBG虽然是一项成熟的技术，但仍需要进一步深入全面的研究，或许还需要基于设备的辅助，以实现更好的重建效果并将供区损伤降至最低。
