Treatment of Early Developed Peri-Implantitis in Fibula Graft Site

Background Indocyanine green (ICG) videoangiography is routinely used to evaluate skin and organ perfusion and to assess patency rates of microvascular anastomoses. This study uses ICG angiography as a novel approach to qualitatively and quantitatively evaluate bone perfusion of microvascular fibula grafts intraoperatively and to assess the effect of fibula segment length and number of osteotomies on bone perfusion. Methods All patients planned for mandible reconstruction using a microvascular fibula graft between January 2013 and May 2017 were considered for this study. ICG videoangiography of cancellous bone perfusion was performed using a handheld ICG camera. Videos were analyzed, and a perfusion curve was generated. Peak enhancement, time to peak, slope, and wash-in area under the curve were extracted; rise time, wash-in rate (WiR), and wash-in perfusion index were calculated. Results were statistically analyzed with regard to distal fibula segment length and number of osteotomy sites. Results Thirty-nine patients (age 59 ± 8 years) were included in the study. Mandible reconstruction was achieved with 1 (n = 15), 2 (n = 13), or 3 (n = 11) fibula segments. The WiR was 6.4 ± 2.3 and 4.4 ± 0.2 before and after proximal osteotomy, respectively. The wash-in perfusion index was 114.2 ± 48.4 before and 84.4 ± 20.0 after proximal osteotomy. Bone perfusion was significantly reduced after additional proximal osteotomies. Both the segment length and number of proximal osteotomies correlated with bone perfusion, with longer segments and fewer osteotomies showing higher perfusion. Conclusion This study demonstrates the feasibility of cancellous bone perfusion analysis using ICG and can serve as a basis for future bone perfusion studies. Additional osteotomies and short segment length negatively affects cancellous bone perfusion of the distal fibula segment in free fibula flaps. The extent to which the observed decrease in arterial inflow to the distal fibula segment affects the further course of healing needs to be addressed in future studies.

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A case of ORIF with fibula graft of 2nd & 3rd metacarpal nonunion

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2018.v4.i2m.121 ◽

2018 ◽

Vol 4 (2.7) ◽

pp. 851-853

Author(s):

Dr. Pankaj Ghogare

Keyword(s):

Fibula Graft

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Two‐staged hindfoot reconstruction with vascularized fibula graft for calcaneal osteomyelitis caused by methicillin‐resistant Staphylococcus aureus : A case report

Microsurgery ◽

10.1002/micr.22070 ◽

2013 ◽

Vol 33 (3) ◽

pp. 232-235 ◽

Cited By ~ 6

Author(s):

Jun Endo ◽

Kazuki Kuniyoshi ◽

Makondo Mochizuki ◽

Katsuhito Shimoyama ◽

Tadaaki Koyama ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Case Report ◽

Methicillin Resistant Staphylococcus Aureus ◽

Methicillin Resistant ◽

Fibula Graft ◽

Vascularized Fibula ◽

Vascularized Fibula Graft

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Intercalary Reconstruction after Wide Resection of Malignant Bone Tumors of the Lower Extremity Using a Composite Graft with a Devitalized Autograft and a Vascularized Fibula

Sarcoma ◽

10.1155/2015/861575 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 15

Author(s):

Koichi Ogura ◽

Shimpei Miyamoto ◽

Minoru Sakuraba ◽

Tomohiro Fujiwara ◽

Hirokazu Chuman ◽

...

Keyword(s):

Lower Extremity ◽

Bone Tumors ◽

Callus Formation ◽

Wide Resection ◽

Rigid Fixation ◽

Malignant Bone Tumors ◽

Fibula Graft ◽

Vascularized Fibula ◽

The Mean ◽

Vascularized Fibula Graft

Introduction. Although several intercalary reconstructions after resection of a lower extremity malignant bone tumor are reported, there are no optimal methods which can provide a long-term reconstruction with fewest complications. We present the outcome of reconstruction using a devitalized autograft and a vascularized fibula graft composite.Materials and Methods.We conducted a retrospective review of 11 patients (7 males, 4 females; median age 27 years) undergoing reconstruction using a devitalized autograft (pasteurization (n=6), deep freezing (n=5)) and a vascularized fibula graft composite for lower extremity malignant bone tumors (femur (n=10), tibia (n=1)).Results. The mean period required for callus formation and bone union was 4.4 months and 9.9 months, respectively. Four postoperative complications occurred in 3 patients: 2 infections (1 pasteurized autograft, 1 frozen autograft) and 1 fracture and 1 implant failure (both in pasteurized autografts). Graft removal was required in 2 patients with infections. The mean MSTS score was 81% at last follow-up.Conclusions.Although some complications were noted in early cases involving a pasteurized autograft, our novel method involving a combination of a frozen autograft with a vascularized fibula graft and rigid fixation with a locking plate may offer better outcomes than previously reported allografts or devitalized autografts.

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Repair and Lengthening After Nonunion of Free Vascularized Fibula Graft for Reconstruction of Osteosarcoma of the Tibia

Limb Lengthening and Reconstruction Surgery Case Atlas ◽

10.1007/978-3-319-02767-8_271-1 ◽

2014 ◽

pp. 1-10

Author(s):

S. Robert Rozbruch

Keyword(s):

Fibula Graft ◽

Vascularized Fibula ◽

Vascularized Fibula Graft

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One-Stage Metatarsal Interposition Lengthening With an Autologous Fibula Graft for Treatment of Brachymetatarsia

Foot & Ankle Specialist ◽

10.1177/1938640018803731 ◽

2018 ◽

Vol 12 (4) ◽

pp. 330-335

Author(s):

Hazibullah Waizy ◽

Hans Polzer ◽

Nils Schikora ◽

Andreas Forth ◽

Felix Becker ◽

...

Keyword(s):

Bone Graft ◽

Plantar Flexion ◽

Treatment Options ◽

Skin Incision ◽

Metatarsal Bone ◽

Distal Fibula ◽

Fibula Graft ◽

Patient Reported ◽

Standing Up ◽

Pain Symptoms

Objective: Brachymetatarsia is defined as the pathological shortening of a metatarsal bone, which can cause cosmetic problems and pain in the forefoot. The main surgical treatment options are: extension osteotomy, interposition of a bone graft, and callus distraction. Usually, a bone graft from the iliac crest is used for the interposition osteotomy. The operative technique of graft extraction from the fibula has not been described in the literature yet. Methods: Eight feet with brachymetatarsia in 5 patients were evaluated retrospectively. The minimum follow-up period was 2 years. Via a dorsal V/Y skin incision, a central osteotomy on the metatarsal bone was done. A graft was obtained from the anterior fibula. The graft was inserted and fixed by a locking plate. Additional soft tissue procedures were done. Results: We had bony consolidation in all cases. The mean extension was 9.01 mm (5.49 to 12.54 mm). This corresponded to a mean 20.3% extension of the entire metatarsal. High patient satisfaction as well as high satisfaction regarding the cosmetic results were achieved. There were no postoperative complications. The range of motion of the metatarsal-phalangeal joint IV was 20% less preoperative in terms of plantar flexion. Standing up on tiptoes was possible in all patients postoperatively. One patient reported mild symptoms after sports activities. Conclusions: Because of its anatomy the graft adapts to the metatarsal IV bone. As our study showed, harvesting from the distal fibula causes no functional restriction. In terms of wound and bone healing as well as pain symptoms, this method should be considered as an alternative to the standard iliac graft.

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