Skip to main content

Advertisement

SpringerLink
Log in

Free fibula flap for humerus segmental reconstruction: report on 13 cases

  • Original Article
  • Published:
La Chirurgia degli Organi di Movimento Aims and scope Submit manuscript

Abstract

In the period between 1994 and 2004, 13 patients (10 male, 3 female) presenting with post-traumatic defects to the humerus were treated with vascularised fibula graft. Age ranged from 21 to 62 (mean 37) years. Length of the bony defect ranged from 6 to 16 cm. Graft fixation was performed with plates in 12 cases, and in one case only screws were used. All patients were clinically reviewed between 120 days and 14 months after surgery. In one patient the flap was lost and a second free fibula flap was performed to achieve the reconstructive goal. Mean time for segmental bony union was 6 months (range from 3 to 13 months). Vascularised fibula graft allows for a successful humerus reconstruction when traditional techniques provide unsatisfactory results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ward EF, Savoie FH III, Hughes JL Jr (1998) Fractures of the diaphyseal humerus. In: Browner BD, Jupiter JB, Levine AM, Trafton PG (eds) Skeletal trauma: fractures, dislocations, ligamentous injuries, Vol 2, 2nd Edn. WB Saunders, Philadelphia, PA, pp 1523–1547

    Google Scholar 

  2. Duffy GP, Wood MB, Rock MG, Sim FH (2000) Vascularized free fibular transfer combined with autografting for the management of fracture nonunions associated with radiation therapy. J Am Bone Joint Surg 82:544–554

    CAS  Google Scholar 

  3. Foster RJ, Dixon GL, Bach AW et al (1985) Internal fixation of fractures and non-unions of the humeral shaft. Indications and results in a multi-center study. J Bone Joint Surg Am 67:857–869

    PubMed  CAS  Google Scholar 

  4. Healy WL, White GM, Mick CA et al (1987) Nonunion of the humeral shaft. Clin Orthop Relat Res 219:206–213

    PubMed  Google Scholar 

  5. Jupiter JB, von Deck M (1998) Ununited humeral diaphyses. J Shoulder Elbow Surg 7:644–653

    Article  PubMed  CAS  Google Scholar 

  6. Jupiter JB (1990) Complex non-union of the humeral diaphysis. J Bone Joint Surg Am 72:701–707

    PubMed  CAS  Google Scholar 

  7. Mast JW, Spiegel PG, Harvey JP (1975) Fractures of the humeral shaft. A retrospective study of 240 adult fractures. Clin Orthop Relat Res 112:254–262

    Article  PubMed  Google Scholar 

  8. Sarmiento A, Zagorski JB, Zych GA et al (2000) Functional bracing for the treatment of fractures of the humeral diaphysis. J Bone Joint Surg 82:478–486

    Article  PubMed  CAS  Google Scholar 

  9. Trotter DH, Dobozi W (1986) Nonunion of the humerus: rigid fixation, bone grafting, and adjunctive bone cement. Clin Orthop Relat Res 204:162–168

    PubMed  Google Scholar 

  10. de Boer HH, Wood MB, Hemans J (1990) Reconstruction of the large skeletal defects by vascularized fibula transfer. Factors that influenced the outcome of union in 62 cases. Int Orthop 14:121–128

    Article  PubMed  Google Scholar 

  11. McKee MD, Miranda MA, Riemer BL et al (1996) Management of humeral non-union after the failure of locking intramedullary nails. J Orthop Trauma 10:492–499

    Article  PubMed  CAS  Google Scholar 

  12. Muramatsu K, Doi K, Ihara K et al (2003) Recalcitrant posttraumatic nonunion of the humerus. Acta Orthop Scand 74:95–97

    Article  PubMed  Google Scholar 

  13. Patel VR, Menon DK, Pool RD, Simonis RB (2000) Nonunion of the humerus after failure of surgical treatment. Management using the Ilizarov circular fixation. J Bone Joint Surg Br 82:977–983

    Article  PubMed  CAS  Google Scholar 

  14. Ring D, Jupiter JB, Quintero J et al (2000) Atrophic ununited diaphyseal fractures of the humerus with a bony defect. J Bone Joint Surg Br 82:867–871

    Article  PubMed  CAS  Google Scholar 

  15. Volgas DA, Stannard JP, Alonso JE (2004) Nonunions of the humerus. Clin Orthop Relat Res 419:46–50

    Article  PubMed  Google Scholar 

  16. Paramasivan ON, Younge DA, Pant R (2000) Treatment of nonunion around the olecranon fossa of the humerus by intramedullary locked nail. J Bone Joint Surg 82-B:977–983

    Google Scholar 

  17. Wu CC (1996) Humeral shaft non-union treated by a Seidel interlocking nail with a supplementary staple. Clin Orthop Relat Res 326:203–208

    Article  PubMed  Google Scholar 

  18. Catagni MA, Guerreschi F, Probe RA (1991) Treatment of humeral nonunions with the Ilizarov technique. Bull Hosp Joint Dis 51:74–83

    CAS  Google Scholar 

  19. Cattaneo R, Catagni MA, Guerreschi F (1993) Applications of the Ilizarov method in the humerus: lengthenings and nonunions. Hand Clin 9:729–739

    PubMed  CAS  Google Scholar 

  20. Ciuccarelli C, Cervellati C, Montanari G et al (1990) Applications of the Ilizarov method for the treatment of nonunion in the humerus. Chir Organi Mov 75:115–120

    PubMed  CAS  Google Scholar 

  21. Lammens J, Bauduin G, Driesen R et al (1998) Treatment of nonunion of the humerus using the Ilizarov external fixator. Clin Orthop Relat Res 353:223–230

    Article  PubMed  Google Scholar 

  22. Barquet A, Fernandez A, Luvizio J, Masliah R (1989) A combined therapeutic protocol for aseptic non-union of the humeral shaft: a report of 25 cases. J Trauma 7:274–278

    Google Scholar 

  23. Heitmann C, Erdmann D, Levin LS (2002) Treatment of segmental defects of the humerus with an osteoseptocutaneous fibular transplant. J Bone Joint Surg Am 84:2216–2223

    PubMed  Google Scholar 

  24. Tu YK, Yen CH, Yeh WL et al (2001) Reconstruction of posttraumatic long bone defect with free vascularized bone graft: good outcome in 48 patients with 6 years’ follow-up. Acta Orthop Scand 72:359–364

    Article  PubMed  CAS  Google Scholar 

  25. Tang CH (1992) Reconstruction of the bones and joints of the upper extremity by vascularized free fibular graft: report of 46 cases. J Reconstr Microsurg 8:285–292

    Article  PubMed  CAS  Google Scholar 

  26. Brunelli GA, Vigasio A, Brunelli GR (1995) Microvascular fibular graft in skeleton reconstruction. Clin Orthop Relat Res 314:241–246

    PubMed  Google Scholar 

  27. Mattar R Jr, Azze RJ, Ferreira MC et al (1994) Vascularized fibular graft for management of severe osteomyelitis of the upper extremity. Microsurgery 15:22–27

    Article  Google Scholar 

  28. Moran CG, Wood MB (1993) Vascularized bone autografts. Orthop Rev 22:187–197

    PubMed  CAS  Google Scholar 

  29. Gonzalez del Pino J, Bartolome del Valle E, Lopez Grana G, Ferreira Villanova J (2004) Free vascularized fibula grafts have a high union rate in atrophic nonunions. Clin Orthop Relat Res 419:38–45

    Article  PubMed  Google Scholar 

  30. Minami A, Kasashima T, Iwasaki N et al (2000) Vascularized fibular grafts: an experience of 102 patients. J Bone Joint Surg Br 82:1022–1025

    Article  PubMed  CAS  Google Scholar 

  31. Lee KS, Park JW (1999) Free vascularized osteocutaneous fibular graft to the tibia. Microsurgery 19:141–147

    Article  PubMed  CAS  Google Scholar 

  32. Falder S, Sinclair JS, Rogers CA, Townsend PLG (2003) Long-term behaviour of the free vascularized fibula following reconstruction of large bony defects. Br J Plastic Surg 56:571–584

    Article  CAS  Google Scholar 

  33. Arai K, Toh S, Tsubo K et al (2002) Complications of vascularized fibula graft for reconstruction of long bones. Plastic Rec Surg 7:2301–2306

    Article  Google Scholar 

  34. Belt PJ, Dickinson IC, Theile DRB (2005) Vascularized free fibular flap in bone resection and reconstruction. Br J Plast Surg 58:425–430

    PubMed  CAS  Google Scholar 

  35. Adani R, Delcroix L, Innocenti M et al (2004) Reconstruction of large posttraumatic skeletal defects of the forearm by vascularized free fibular graft. Microsurgery 6:423–429

    Article  Google Scholar 

  36. Delcroix L, Adani R, Innocenti M et al (2005) Le ricostruzioni diafisarie dell’arto superiore con il perone vascolarizzato. GIOT XXXI[Suppl 2]:481–489

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dipartimento Integrato di Emergenza-Urgenza Clinica Ortopedica e Traumatologica Azienda Ospedaliera Universitaria Policlinico di Modena, Università degli Studi di Modena e Reggio Emilia, Largo del Pozzo 71, 41100, Modena, Italy

    Roberto Adani, Luigi Tarallo & Alessio Baccarani

  2. SODS Microchirurgia, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Luca Delcroix & Marco Innocenti

Authors
  1. Roberto Adani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luca Delcroix
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marco Innocenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luigi Tarallo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alessio Baccarani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roberto Adani.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Adani, R., Delcroix, L., Innocenti, M. et al. Free fibula flap for humerus segmental reconstruction: report on 13 cases. Chir Organi Mov 91, 21–26 (2008). https://doi.org/10.1007/s12306-007-0004-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12306-007-0004-5

Keywords

Search

Navigation