TREATMENT OF POSTTRAUMATIC SEGMENTAL BONE DEFECTS OF THE TIBIA THROUGH THE RECONSTRUCTION WITH NON-VASCULARISED ILIAC CREST BONE GRAFT VERSUS MICROSURGICAL DOUBLE-BARREL VASCULARISED FIBULAR FLAP TRANSFER
Abstract:
Purpose: The treatment of segmental bone defects of the tibia after high-energy calf
trauma is demanding for both, orthopaedic and plastic surgeons. Multiple treatment options are
available, including non-vascularised bone grafts, allografts, bone substitutes, callus distraction,
and free vascularised bone transfers. We shall present, herein, two small series of patients with
major segmental defects of the tibia treated by reconstruction of the tibia with non-vascularised
iliac crest bone grafts (NVIBG) and micro-surgically transferred double-barrel fibular
osteomusculocutaneous flap. Materials and Methods: Patients with segmental bone defects of the
tibia, 5 cm or more in length, have been included in the two series. The bone reconstruction of the
tibia was performed by means of non-vascularised bone grafts harvested from the iliac crest and
double-barrel fibular osteomusculocutaneous flap. Bone fixation has been ensured through
external fixation in two cases and screws and initial external fixation followed by early conversion
to locking plate internal fixation in the other cases. Results: In all cases included in the two series,
bone union has been achieved. No case of irreversible graft loss or infection occurred in the
process. Stress fractures developed in the cases treated by non-vascularised iliac crest bone grafts
reconstruction. Time to bone union was of 25 months in the cases treated with non-vascularised
iliac crest bone graft and, 5 to 8 months in the cases treated with double-barrel free vascularised
fibular graft. Conclusions: The use of double-barrel free vascularised fibular flap was successful
and it is the best option in the management of segmental tibial defects. Treatment with nonvascularised
iliac crest graft can be successful in segmental bone defects of the tibia not exceeding
10 cm, but this requires a longer recovery time.
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