Free vascularized fibular transplant. A new method for monitoring circulation of the grafted fibula.

Free vascularized fibular grafts were used to treat seventeen patients who had extensive defects and pseudarthroses in long bones of the extremities. Of the seventeen, thirteen had been followed for from eighteen months to five years and could be evaluated. All thirteen grafts healed with no radiographic evidence of bone necrosis or resorption. During the immediate postoperative period, the patency of the anastomoses was monitored by observing the color of the skin of an island pedicle (so-called buoy) skin graft whose blood supply was in continuity with that of the fibular graft. Preoperative Doppler measurements were used to determine the most favorable location for the island pedicle graft. In the presence of defects of both bone and skin, the skin defect can be covered by using a large buoy flap. The largest flap used in this series measured fifteen square centimeters.