Treatment of congenital pseudarthrosis of the tibia with free vascularized bone graft.

Considering the often poor results obtained with conventional methods of bone grafting in the treatment of congenital pseudarthrosis of the tibia, the free vascularized bone graft may offer the best chance of cure to these unfortunate patients. A segment of rib or fibula may be harvested with its vascular supply and used as a graft to the involved segment of the tibia, using microvascular techniques to anastomose its vasculature to that of the affected leg. The advantages of this approach include a one stage procedure with minimal hospitalization, and a minimal donor defect especially when the rib is used. Although the procedure is time consuming the overall operative effort is far less than that of multiple procedures often needed with conventional methods of grafting. Although published reports are few, preliminary reports from microsurgeons using this technique indicate a high success rate, even after previous failures of conventional grafts. The increasing use of microvascular free bone transfers may eliminate the need for amputation in many of these children.