The use of a vascularized fibular flap in the treatment and surgical rehabilitation of military trauma patients
DOI:
https://doi.org/10.14739/2310-1210.2024.6.312480Keywords:
fibula flap, bone defects, reconstructive surgery, military injury, rehabilitationAbstract
Aim. The purpose of the work is to demonstrate the possibilities of using a vascularized fibular flap to replace bone defects in the treatment of acute military trauma and its consequences at the rehabilitation stage.
Materials and methods. An anatomical feature description of the vascularized fibular flap with a cutaneous component. Clinical cases of the vascularized fibular flap use to reconstruct bone and soft tissue defects after military injuries. In the presented cases, vascularized fibula osteocutaneous flaps were used.
Results. Two clinical cases of reconstruction using the fibula flap are presented. The first case presents a patient with a total mandibular defect resulting from a gunshot wound. The second case presents a patient with consequences of a mine-shrapnel injury of the left forearm and an ulnar defect of about 12 cm in length and the resultant inability to perform rotational movements. Vascularized fibula osteocutaneous flaps were used for reconstruction in both cases being transferred to the recipient site, and microvascular anastomoses were performed for flap reperfusion.
Conclusions. Adding a free fibula flap to the reconstructive surgeon’s arsenal enables one-stage reconstructions of large wounds with bone defects after injuries or oncological resections without significant musculoskeletal functional loss to donor limbs.
References
Fox JP, Markov NP, Markov AM, O’Reilly E, Latham KP. Plastic Surgery at War: A Scoping Review of Current Conflicts. Mil Med. 2021;186(3-4):e327-35. doi: https://doi.org/10.1093/milmed/usaa361
Tsymbalyuk VI, editor. [Gunshot wounds of soft tissues (Experience of an anti-terrorist operationOperations of the united forces)]. Kharkiv, Ukraine: Kolegium; 2020. Ukrainian.
Sliesarenko SV, Badiul PО, Rudenko OI, Romanshuk MI. Keystone perforator island flaps in the reconstruction of lower limb defects resulting from shrapnel and mine-explosive combat injuries. Case series. General Surgery (Ukraine). 2023;0(1):48-57. doi: https://doi.org/10.30978/GS-2023-1-48
Blondeel PN, Morris SF, Hallock GG, Neligan PC. Perforator Flaps: anatomy, technique and clinical applications. Thieme; 2024.
Zeiderman MR, Pu LLQ. Free-Style Free Perforator Flaps in Lower Extremity Reconstruction. Clin Plast Surg. 2021;48(2):215-23. doi: https://doi.org/10.1016/j.cps.2020.12.001
Bibbo C. The Free Fibula Flap for Lower Extremity Reconstruction. Clin Podiatr Med Surg. 2021;38(1):117-30. doi: https://doi.org/10.1016/j.cpm.2020.09.007
Liu K, Zhang W, Wang Y, Xiang DW, Shi HB, Liu QL. Fibula osteal flap with proximal peroneal perforator skin paddle for composite oromandibular reconstruction: A case report. Medicine (Baltimore). 2020;99(50):e23590. doi: https://doi.org/10.1097/MD.0000000000023590
Lai YS, Lai YH, Lee YC. Impact of fibula osteoseptocutaneous flap laterality in mandibular and intraoral reconstruction. J Plast Reconstr Aesthet Surg. 2023;86:199-204. doi: https://doi.org/10.1016/j.bjps.2023.08.026
Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plastic and Reconstructive Surgery. 1975;55(5):533-44. doi: https://doi.org/10.1097/00006534-197505000-00002
Sliesarenko SV, Badiul PO. Perforantni klapti v rekonstruktyvnii khirurhii. Atlas. Dnipro, Ukraine: Art-Pres; 2021. Ukrainian.
Rozbruch SR, Ilizarov S, editors. Limb lengthening and reconstruction surgery. Boca Raton, FL: CRC Press; 2006.
Errani C, Alfaro PA, Ponz V, Colangeli M, Donati DM, Manfrini M. Does the Addition of a Vascularized Fibula Improve the Results of a Massive Bone Allograft Alone for Intercalary Femur Reconstruction of Malignant Bone Tumors in Children?. Clin Orthop Relat Res. 2021;479(6):1296-308. doi: https://doi.org/10.1097/CORR.0000000000001639
Mericli AF, Asaad M, Lewis VO, Lin PP, Goodenough CJ, Adelman DM, et al. Free Fibula Flap for Extremity Oncologic Defects: Factors Influencing Union and Functional Outcomes. Plast Reconstr Surg. 2023;151(4):885-96. doi: https://doi.org/10.1097/PRS.0000000000010014
Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg. 1989;84(1):71-9.
Pan Z, Xue S, Gao P, Zhao Y, Li H. Free Double-Barrel Vascularized Fibular Graft for Two-Bone Forearm Reconstruction After Tumor Resection: A Case Report. JBJS Case Connect. 2021;11(4). doi: https://doi.org/10.2106/JBJS.CC.21.00275
Richard MJ, DiPrinzio EV, Lorenzana DJ, Whitlock KG, Hein RE, Urbaniak JR. Outcomes of free vascularized fibular graft for post-traumatic osteonecrosis of the femoral head. Injury. 2021;52(12):3653-9. doi: https://doi.org/10.1016/j.injury.2021.04.005
Knitschke M, Yonan M, Roller FC, Pons-Kühnemann J, Attia S, Howaldt HP, et al. Osseous Union after Jaw Reconstruction with Fibula-Free Flap: Conventional vs. CAD/CAM Patient-Specific Implants. Cancers (Basel). 2022;14(23):5774. doi: https://doi.org/10.3390/cancers14235774
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