Early experience in a high complexity Hospital with the vascularized fibular graft in segmental bone defects of the upper limb.

Abstract

Introduction Reconstruction of bone defects greater than 6 cm in the upper limb is a difficult problem. Some of the surgical procedures described to treat them are: the use of allogeneic bone graft, the Masquelet technique and the vascularized fibular graft (VFG). The VFG has become the most popularized method to treat this bone defects, because of their biological advantages. The aim of this study was to evaluate the rate of bony union and the time to accomplish this union and the complications associated with this technique in a continuous series of patients. Material and methods A review in our database was performed to identify all patients who underwent reconstruction with VFG for a period of five years. All patients who were treated for defects larger than 6 cm on upper limbs were included. Reconstructions on lower limbs or associated for augmentation stability in shoulder arthrodesis were excluded. Preoperative, intraoperative, and immediate and long-term postoterative variables were analyzed. Results During the assessment period, 18 patients underwent reconstructive surgery with VFG. Six patients (4 males / 2 females) met the inclusion criteria. The average age was 47 years old (range 16 to 66 years). On average, patients had three previous surgeries (range 1 to 4). The time between the initial trauma and reconstructive surgery ranged from 2 to 21 years (mean 7 years). The causes of the defect were post-traumatic (nonunion) sequel in five patients and oncological disease in a patient with a Giant Cells Tumor. The bone segments involved were the humerus (three patients), radius (two), and ulna (one). The average bone defect was 10 cm (range 6 to 15 cm). An osteocutaneous fibular graft was performed in five cases, and in one case without associated skin flap. In all cases, we used locked fixation plates. The average follow-up was 17 months (range 5 to 40 months). Bone healing was achieved in all cases. Bone healing was on average 16 weeks (range 8 to 22 weeks). Two patients had postoperative complications. One of them had an exposure of hardware. The other one suffered loosening of the internal fixation. None of the patients had complications or functional sequelae in the donor site. Conclusion The VFG is a valid option in reconstructive surgery of segmental bone defects larger than 6 cm in the upper limb. It has a high consolidation rate, even in cases with multiple previous surgeries or long evolution time. The technical details prevent complications in the donor site.

Keywords

• peroné vascularizado
• defecto óseo
• cirugía reconstructiva
• fibular graft
• bone defect
• reconstructive surgery