Glynou Sevasti P, Georgiannakis Ariadni, Ardolino Daria, Craxford Simon, Vris Alexandros
Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
Institute of Health, Medicine and Environments, Brunel University of London, United Kingdom.
Strategies Trauma Limb Reconstr. 2025 Jan-Apr;20(1):37-46. doi: 10.5005/jp-journals-10080-1643. Epub 2025 Aug 18.
Managing post-traumatic critical bone defects in the tibia remains challenging. Vascularised free fibula grafts (VFFG) are an attractive option due to their versatility and ability to integrate with host bone. However, they are challenging, and their role compared to alternative techniques, such as bone transport and Masquelet, remains unclear. This study aims to assess the safety and effectiveness of free fibula flaps in reconstructing critical tibia defects following trauma.
Five databases were searched for English-language studies from inception until August 2024. Inclusion criteria involved adult patients undergoing VFFG to the tibia for trauma-induced bone defects. Case reports and studies involving non-traumatic and/or critical bone injury and/or those not undergoing fibula transfer were excluded. Bias was assessed using the ROBINS-I tool.
Fifteen studies involving 83 patients with a mean age of 35.07 ± 12.16 (range: 18-65) were included. Ipsilateral fibula transfer was preferred ( = 13, 80%), of and 89.7% fibulas ( = 35) were transferred using a single-barrel approach. The average union rate was 93.08% (95% CI: 86.56, 99.61) across the 74 patients where union outcomes were reported. Flap survival was 100% in seven studies, whilst two studies reported lower survival rates, the lowest being 50%. The overall complication rate was 39.98% (95% CI: 28.25, 51.71), with stress fractures occurring in 35.5% ( = 16) of cases. Revision rates varied from 10 to 40%. The risk of bias was high in 12 studies, and only three studies had a moderate risk. Four studies compared VFFG to alternative management strategies.
Vascularised free fibula grafts are effective for reconstructing large segmental tibia defects post-trauma, achieving high union and flap survival rates. However, complication rates are high, and study heterogeneity limits definitive conclusions on the technique's superiority. Further prospective comparative studies are required to characterise the role of VFFG.
How to cite this article: Glynou SP, Georgiannakis A, Ardolino D, . Vascularised Fibula Transfer for Post-traumatic Critical Tibial Bone Defects: A Systematic Review. Strategies Trauma Limb Reconstr 2025;20(1):37-46.
处理胫骨创伤后严重骨缺损仍然具有挑战性。带血管游离腓骨移植（VFFG）因其多功能性以及与宿主骨整合的能力而成为一种有吸引力的选择。然而，这种手术具有挑战性，与其他技术（如骨搬运和Masquelet技术）相比，其作用仍不明确。本研究旨在评估游离腓骨瓣在重建创伤后胫骨严重缺损中的安全性和有效性。
检索了五个数据库，查找从数据库建立至2024年8月的英文研究。纳入标准包括因创伤性骨缺损接受胫骨VFFG的成年患者。排除病例报告以及涉及非创伤性和/或严重骨损伤和/或未进行腓骨转移的研究。使用ROBINS - I工具评估偏倚。
纳入了15项研究，共83例患者，平均年龄为35.07±12.16岁（范围：18 - 65岁）。同侧腓骨转移更受青睐（n = 13，80%），89.7%的腓骨（n = 35）采用单筒法转移。在报告愈合结果的74例患者中，平均愈合率为93.08%（95%CI：86.56，99.61）。7项研究中皮瓣存活率为100%，而2项研究报告了较低的存活率，最低为50%。总体并发症发生率为39.98%（95%CI：28.25，51.71），35.5%（n = 16）的病例发生应力性骨折。翻修率从10%到40%不等。12项研究的偏倚风险较高，只有3项研究具有中度风险。4项研究将VFFG与其他治疗策略进行了比较。
带血管游离腓骨移植在重建创伤后胫骨大段缺损方面是有效的，实现了高愈合率和皮瓣存活率。然而，并发症发生率较高，研究的异质性限制了对该技术优越性得出明确结论。需要进一步进行前瞻性比较研究来明确VFFG的作用。
如何引用本文：Glynou SP, Georgiannakis A, Ardolino D, 等。创伤后胫骨严重骨缺损的带血管腓骨转移：一项系统评价。创伤肢体重建策略2025；20(1)：37 - 46。
