Microvascular fibular grafts in skeleton reconstruction.

Extensive bone defects from any cause require large bone grafts. Such large defects usually cannot be repaired by conventional, nonvascularized cancellous grafts. Before the advent of microsurgery, many of these lesions could not be cured, and amputation was often the only solution. The bone may be transferred alone or in combination with skin or muscle or both. Idiopathic femoral head necrosis is 1 of the main indications for free microvascular (fibular) transfer. The authors propose a new classification for idiopathic femoral head necrosis. A technique that has been used for the past 14 years, on providing mechanical support and improved blood supply to the femoral head, is described. The fibula is favored for its mechanical properties and its vascular pedicle, and because it is easier to harvest.