engleski

Reconstruction of articular defects of upper extremity long bones after tumor resection using free single pedicled vascularized fibula with fibular head

Purpose: Fibula flap as a vascularized bone has an important place in reconstructive surgery for nearly 30 years. The flap is rised on peroneal artery. The posibility of taking proximal epiphysis with large part of fibula on single vascular pedicle for long bone replacement is quite contraversal. In this paper the authors present 5 years follow-up after using proximal epiphysis and large part of fibula on single vascular pedicle for long bone reconstruction after tumor resection in two young female patients. Material and method: Reconstruction of 16 cm long bone defect of proximal right humerus in 14 years old girl and 17 cm long bone defect of distal radius in 16 years old girl has been performed after resection of the osteosarcoma. Free singlepedicled vascularized proximal fibular flap was used to reconstruct a skeletal defect. The stability of the reconstructed sholder and wrist joint was maintained by suturing the fibular ligament to humeral capsula, or to palmar collateral ligament around the wrist. Results: The postoperative period was uneventful. X-rays and scintigram confirmed good bone healing and normal perfusion of the flap. On follow-up 5 years postoperatively, the functional result of the patient with humerus reconstruction was rated as very good. Excellent elbow and wrist-hand function were noted, but the shoulder abduction and anteflexion remained limited. Radiograps of the forarm showed absorption and collapse of the head of the fibula in second patient, but with no significant functional problems related to absorption. No instability of the knee joint was observed in both patients. Conclusion: After radical resection of the malignant tumors affecting upper humerus or distal radius singlepedicled proximal free fibula flap can be safetly included for long bone replacement with satisfactory local function and without any negative implications on knee function.

free fibula flap; long bone reconstruction

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