317. FREE FIBULAR FLAP FOR LIMB BONE RECONSTRUCTION: 22 CASES

Abstract

Purpose of the study: This retrospective study evaluated the results, complications and sequelae of 22 free fibular flaps used for bone reconstructions of the limbs assessed at mean 44.4 months.

Material and methods: The tissue loss was the result of trauma in 20 patients and followed cancerology surgery in two. The localisations involved the upper limb in 15 patients and the lower limb in seven. Mean length of bone loss was 11.1 cm. Six injuries required skin cover in addition to the fibular flap. Five patients had had a cement spacer. Fixation methods were: internal fixation (n=14) and external fixation (n=8). Classical vessel anastomosis (one vein, one artery) was used in eight patients and a bridge method (recipient site artery by a fibular artery) in 14 patients.

Results: Bone healing was achieved in 15 patients in 6.7 months on average. Healing was secondary in four patients after corticocancellous grafting. Three flaps failed. Factors significantly associated with favourable healing were: long time from trauma to flap repair, small size of the initial skin opening, first-intention Masquelet, internal fixation, and first-intention cancellous autologous graft. Early postoperative complications of the recipient site included two haematomas and three superficial skin deficiencies. Two graft fractures occurred in one patient and healed after orthopaedic treatment. There were few donor site problems: two early haematomas and two retractions of the flexor hallucis longus. Mean morbidity scores revealed very good results: 1.23/16 with the Point Evaluation System, 93.16/100 for the Karlsson score, and 94.29100 for the Kitaoka score. Globally, the functional assessment of the fibular flap was excellent for three patients, good for eleven, fair for four and poor for one.

Discussion: Our healing rates and durations were not statistically different from earlier reports in the literature. We focused on rigorous preparation in terms of debridement and antibiotic therapy, insertion of a spacer, internal fixation, and complementary first-intention autologous bone graft. In addition, we propose a bridging anastomosis which simplifies the technique and gives the same results as the classical anastomosis methods.