Complication of osteo reconstruction by utilizing free vascularized fibular bone graft
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REVIEW
Open Access
Complication of osteo reconstruction by utilizing free vascularized fibular bone graft Qifeng Ou, Panfeng Wu, Zhengbing Zhou, Ding Pan and Ju-yu Tang*
Abstract The success of free vascularized fibular bone graft (FVFBG) has accelerated the osteo reconstruction which results from trauma, resection of a tumor or an infectious bone segment, or correction of congenital deformity. But the complication behind should not be overlooked. The failure could necessitate a second surgery, which prolong the rehabilitation period and produce further health cost. Worst, the patients may suffer a permanent impaired ankle function, or a sustained morpho-functional loss on reconstructive area which are hard to save. To provide an overview of the complication related to reconstruction by FVFBG, a narrative review is conducted to identify the complications including their types and rates, the contributing factors, the approaches to measure and the techniques to avoid. Methodologically, by quick research on Pubmed and abstract reading of reviews, we characterize five reconstructive areas where FVFBG were most frequently applied: extremities, mandible, spine, osteonecrosis of femoral head, and penile. Following, the complications on different reconstructive areas are retrieved, studied and presented in five (or more specifically, six) separate sections. By the way, meaningful difference between FVFBG and other bone flap was presented in a few words if necessary. Donor-site morbidities were studied and summarized as a whole. In these literatures, the evidences documented on limb and mandibular reconstruction have the fullest detail, followed by the spine and lastly the penile. In conclusion, FVFBG, though a mature technique, needs further deep and comprehensive study and maybe device-based assistance to achieve better reconstructive effect and minimize donor-site damage. Keywords: Free vascularized fibular graft, Extremities, Spine, Mandible, Fibular epiphyseal transfer, Osteo reconstruction, Complication
Background Since 1986, the free vascularized fibular bone graft (FVFBG) has been increasingly applied in restoration of bone defect because of trauma, tumors, infection or congenital anomalies. Due to its integration potential and abundant blood supply, it also has a varied utilization in spinal fusion and osteonecrosis of femoral head. What is more, its advantages in rigidity extend its application in phalloplasty. Owing to the advancements in microsurgery, vascular compromise and flap failure have largely * Correspondence: [email protected] Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, No.87 XiangYa Road, Changsha 410008, Hunan, China
been avoided and many researches declare a low incidence rate of complication both on recipient site and donor site. However, complication like stress fracture and non-union could fail the rebuilding process, and donor-site morbidities like valgus ankle deformity or great-toe flexing contracture could lead to impaired walking abilit
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