The Vascularized Fibula as Salvage Procedure in Extremity Reconstruction: A Retrospective Analysis of Time to Heal and Possible Confounders
The vascularized fibula transfer is a well-established technique for extremity reconstruction, but operative planning and patient selection remains crucial. Although recently developed techniques for bone reconstruction, such as bone segment transfer, are becoming increasingly popular, bone defects...
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MDPI AG
2024-02-01
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| Online Access: | https://www.mdpi.com/2075-1729/14/3/318 |
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| author | Christian Smolle Judith C. J. Holzer-Geissler Patrick Mandal Jessica Schwaller Gert Petje Johannes Rois Lars-Peter Kamolz Werner Girsch |
| author_facet | Christian Smolle Judith C. J. Holzer-Geissler Patrick Mandal Jessica Schwaller Gert Petje Johannes Rois Lars-Peter Kamolz Werner Girsch |
| author_sort | Christian Smolle |
| collection | DOAJ |
| description | The vascularized fibula transfer is a well-established technique for extremity reconstruction, but operative planning and patient selection remains crucial. Although recently developed techniques for bone reconstruction, such as bone segment transfer, are becoming increasingly popular, bone defects may still require vascularized bone grafts under certain circumstances. In this study, 41 cases, 28 (68%) men and 13 (32%) women (median age: 40 years), were retrospectively analyzed. Therapy-specific data (flap vascularity [free vs. pedicled] size in cm and configuration [single- vs. double-barrel], mode of fixation [internal/external]) and potential risk factors were ascertained. Indications for reconstruction were osteomyelitis at host site (<i>n</i> = 23, 55%), pseudarthrosis (<i>n</i> = 8, 20%), congenital deformity (<i>n</i> = 6, 15%), traumatic defect, and giant cell tumor of the bone (<i>n</i> = 2, 5% each). Complete healing occurred in 34 (83%) patients after a median time of 6 months. Confounders for prolonged healing were female gender (<i>p</i> = 0.002), reconstruction in the lower limb (<i>p</i> = 0.011), smoking (<i>p</i> = 0.049), and the use of an external fixator (<i>p</i> = 0.009). Six (15%) patients required secondary limb amputation due to reconstruction failure, and one patient had persistent pseudarthrosis at last follow-up. The only risk factor for amputation assessed via logistic regression analysis was preexisting PAOD (peripheral artery occlusive disease; <i>p</i> = 0.008) The free fibula is a reliable tool for extremity reconstruction in various cases, but time to full osseous integration may exceed six months. Patients should be encouraged to cease smoking as it is a modifiable risk factor. |
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| last_indexed | 2024-04-24T18:04:44Z |
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| spelling | doaj.art-5da6789bd2fe4c46a653317b93a9c8692024-03-27T13:51:08ZengMDPI AGLife2075-17292024-02-0114331810.3390/life14030318The Vascularized Fibula as Salvage Procedure in Extremity Reconstruction: A Retrospective Analysis of Time to Heal and Possible ConfoundersChristian Smolle0Judith C. J. Holzer-Geissler1Patrick Mandal2Jessica Schwaller3Gert Petje4Johannes Rois5Lars-Peter Kamolz6Werner Girsch7Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, AustriaDivision of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, AustriaDivision of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, AustriaOrthopaedic Hospital Speising, 1130 Vienna, AustriaOrthopaedic Hospital Speising, 1130 Vienna, AustriaAUVA Trauma Centre Meidling, 1120 Vienna, AustriaDivision of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, AustriaDivision of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, AustriaThe vascularized fibula transfer is a well-established technique for extremity reconstruction, but operative planning and patient selection remains crucial. Although recently developed techniques for bone reconstruction, such as bone segment transfer, are becoming increasingly popular, bone defects may still require vascularized bone grafts under certain circumstances. In this study, 41 cases, 28 (68%) men and 13 (32%) women (median age: 40 years), were retrospectively analyzed. Therapy-specific data (flap vascularity [free vs. pedicled] size in cm and configuration [single- vs. double-barrel], mode of fixation [internal/external]) and potential risk factors were ascertained. Indications for reconstruction were osteomyelitis at host site (<i>n</i> = 23, 55%), pseudarthrosis (<i>n</i> = 8, 20%), congenital deformity (<i>n</i> = 6, 15%), traumatic defect, and giant cell tumor of the bone (<i>n</i> = 2, 5% each). Complete healing occurred in 34 (83%) patients after a median time of 6 months. Confounders for prolonged healing were female gender (<i>p</i> = 0.002), reconstruction in the lower limb (<i>p</i> = 0.011), smoking (<i>p</i> = 0.049), and the use of an external fixator (<i>p</i> = 0.009). Six (15%) patients required secondary limb amputation due to reconstruction failure, and one patient had persistent pseudarthrosis at last follow-up. The only risk factor for amputation assessed via logistic regression analysis was preexisting PAOD (peripheral artery occlusive disease; <i>p</i> = 0.008) The free fibula is a reliable tool for extremity reconstruction in various cases, but time to full osseous integration may exceed six months. Patients should be encouraged to cease smoking as it is a modifiable risk factor.https://www.mdpi.com/2075-1729/14/3/318extremity reconstructionvascularized fibula graftbone graftosseous incorporationhealing timegender disparities |
| spellingShingle | Christian Smolle Judith C. J. Holzer-Geissler Patrick Mandal Jessica Schwaller Gert Petje Johannes Rois Lars-Peter Kamolz Werner Girsch The Vascularized Fibula as Salvage Procedure in Extremity Reconstruction: A Retrospective Analysis of Time to Heal and Possible Confounders Life extremity reconstruction vascularized fibula graft bone graft osseous incorporation healing time gender disparities |
| title | The Vascularized Fibula as Salvage Procedure in Extremity Reconstruction: A Retrospective Analysis of Time to Heal and Possible Confounders |
| title_full | The Vascularized Fibula as Salvage Procedure in Extremity Reconstruction: A Retrospective Analysis of Time to Heal and Possible Confounders |
| title_fullStr | The Vascularized Fibula as Salvage Procedure in Extremity Reconstruction: A Retrospective Analysis of Time to Heal and Possible Confounders |
| title_full_unstemmed | The Vascularized Fibula as Salvage Procedure in Extremity Reconstruction: A Retrospective Analysis of Time to Heal and Possible Confounders |
| title_short | The Vascularized Fibula as Salvage Procedure in Extremity Reconstruction: A Retrospective Analysis of Time to Heal and Possible Confounders |
| title_sort | vascularized fibula as salvage procedure in extremity reconstruction a retrospective analysis of time to heal and possible confounders |
| topic | extremity reconstruction vascularized fibula graft bone graft osseous incorporation healing time gender disparities |
| url | https://www.mdpi.com/2075-1729/14/3/318 |
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