• Archives of Reconstructive Microsurgery
• /
• v.11 no.1
• /
• pp.67-72
• /
• 2002

Purpose : Treatment of giant cell tumor of distal radius can be treated in several ways according to the agressiveness of the tumor. We treated 3 cases of widely involved giant cell tumor of distal radius with wide resection and proximal fibular graft and report the results with review of literatures. Material and Method : We have treated 3 cases of giant cell tumor of the distal radius since last 1990. Among 3 cases, two cases were grade III radiologically and treated by wide resection of distal radius and vascularized proximal fibular graft, and one case, grade II radiologically, treated by distal radial resection and non-vascularized proximal fibular graft. We followed up clinical results of above three cases 9 years, 12 years and 2 years. Result : In all three cases, tranplanted fibula graft showed solid union but grade III tumors recurred at 4 year and 6 year postoperatively. One of the case which recurred 4 year later was treated with secondary wide resection and wrist fusion with autogenous iliac bone graft, and didn't show any recurrent finding for these 5 years after re-operation. And another grade III, which recurred at 6th post-operative year, is under follow-up for 6 years after recur without 2nd operation. Grade II case didn't show any recurrent findings on 2 year follow-up. Conclusion : Grade III cases recurred at 4 year and 6 year follow-up. The cause of recurrence was thought to be invasion of remaining tumor cell in the soft tissue. To prevent recurrence, complete resection of primary tumor was necessary.

• Archives of Reconstructive Microsurgery
• /
• v.9 no.1
• /
• pp.27-36
• /
• 2000

February 1995 to September 1999, authors have experienced seven cases of infected nonunion of tibial fractures with associated soft tissue injury and skin defect, and have accomplished union in all cases by free vascularized fibular graft. All grafts healed with no radiographic evidence of bone necrosis or resorption and have been able to treat large bony defect and skin defect simultaneously. In this study, five cases of vascularized free fibular osteocutaneous flap transfer and two cases of free fibular graft are reported. All of seven cases were infected nonunion of tibia. The results were obtained as follows 1) The mean duration of the radiologic bone union was average 5.3months. 2) Grafted fibular has been hypertrophied, average 10.6 months. 3) In five cases of preservation of posterior cortex of tibia, bony union and hypertrophy of grafted bone were earlier than that two cases of complete segmental resection of tibia. 4) In two cases which only free vascularized fibular graft were performed because achievement of cutaneous flap was failed, authors found that soft tissue defect was filled with granulation tissue and split-thickness skin graft was possible over the granulation tissue after 3 weeks postoperatively.

• Archives of Reconstructive Microsurgery
• /
• v.15 no.2
• /
• pp.111-116
• /
• 2006

An infection after total knee arthroplasty has many complications such as severe bone defect, skin and soft tissue problems, devastated general condition, so arthrodesis is preferred as treatment option. However, poor bony contact due to severe bone defect and inadequate conditions of the soft tissue often cause nonunion or severe limb shortening after arthrodesis. More over these conditions, it is not easy to choose appropriate fixative devices. In these situations, the arthrodesis using vascularized fibular graft can be the solution. Vascularized fibular graft (VFG) can playa role as a suitable material for the treatment of bone defects. And VFG can overcome poor blood circulation caused by scar tissues, and can be relatively more durable and adequate length. In the long term, VFG can be hypertrophied by weight bearing, and will give mechanical stablility. The purpose of the paper is to report the successful results of arthrodesis using VFG in a patient who got extensive bone defect after failed revision total knee arthroplasty with infection.

• Archives of Reconstructive Microsurgery
• /
• v.3 no.1
• /
• pp.9-15
• /
• 1994

It is difficult to obtain a satisfactory bony union of large bone defect secondary to trauma, tumor resection, congenital pseudarthrosis of tibia and bony metaplasia following infection with conventional methods. Conventional nonvascularized autologous bone graft do not provide adequate large amounts of donor bone and usually undergo necrosis or nonunion due to lack of vascular nutrition. Currently, advanced in microsurgery have made it possible to provide a continuing circulation of blood in bone grafts so as to ensure viability. With the nutrient blood supply preserved, healing of the graft to the recipient bone is facilitated without the usual replacement of the graft by creeping substitution. Thus, the grafted bone is achieved more rapid stabilization without sacrificing viability. We reviewed 11 cases of vascularized fibular grafts which were performed from December 1982 to January 1993 and the following results were obtained: 1. Large bone defects with chronic osteomyelitis secondary to trauma were could be successfully treated by the vascularized fibular transfer. 2. In our experience, the vascularized fibular transfer was thought to be one of good methods of treatment for congenital pseudathrosis of tibia. 3. Complete tumor resection was followed by a free vascularized fibular transfer, resulting in good functional improvement, without local recurrence. Long bone defect secondary to bony dysplasia was could be reconstructed by the vascularized fibular transfer. 4. The transferred vascularized fibula had been hypertrophied with bony union during follow-up period and there was no resorption of the grafted fibula.

• The Journal of the Korean bone and joint tumor society
• /
• v.1 no.2
• /
• pp.171-180
• /
• 1995

Recently vascularized fibular transfer has been used in the treatment of bone tumor that are more than six centimeter in length. With refinements in microsurgical techniques and understanding of the biological and biomechanical characteristics of vascularized bone graft, the success rate of this procedure was increased. Fifteen bone tumor patients, sixteen cases seen from Apr. 1979 to Jun. 1995 were managed by means of vascularized bone graft at Kyung Hee University Hospital. Ten cases were done intercalary graft and the others were done osteoarticular graft. the ratio of male and female was 6 : 9, and mean age was 20.4 years old at operation. Mean follow up period was 5 years 4 months(range 17 months to 16 years 2 months) and mean graft length was 13.8cm. Duration for union was 5.3 months(range 3 months to 1 year) and over-all rate of union at the last follow up examination was 93.8%. Sufficient hypertrophy of grafted bone was obtained in all cases at the time of last follow up as compared to initial size of grafted bone. Several complications were found such as stress fractures, recurrence. Vascularized fibular transfer for the treatment of bone tumor is a valuable procedure in appropriately selected patients.

• The Journal of the Korean bone and joint tumor society
• /
• v.4 no.2
• /
• pp.103-106
• /
• 1998

Giant cell tumor was described by Sir Astley Cooper in 1818. This tumor is considered to be a benign tumor but has problems of recurrence and metastatic change after treatment. Methods of operative treatment of this tumor have included currettage, currettage and bone graft, excision, resection, excision and graft and amputation. We experienced a case of giant cell tumor which involved the distal part of right radius and treated by wide excision and fibular graft. The postoperative courses have been satisfactory because of no recurrence or malignant change. After 6 years and 1 month follow up, the patient was able to return to daily life without any problem.

• Archives of Reconstructive Microsurgery
• /
• v.9 no.1
• /
• pp.49-55
• /
• 2000

Nonunion and avascular necrosis are well-recognized complications of severe ankle injury especially aftrer talar neck fracture. The treatment of avascular necrosis is controversial and methods of treatment are limited. Many modalities have been introduced for the treatment of avascular necrosis of talus. The prolonged non-weight bearing for 2~3 years is not practical but also is occasionally complicated by late segmental collapse. Operative treatment includes tibiotalar arthrodesis and talectomy with tibiocalcaneal arthrodesis, but arthrodesis in patients with talar avascular necrosis is technically demanding and cause stiff, immobile foot and relatively high failure rate was reported. It is desirable to preserve their original joint if possible. Vascularized fibular grafting has been reported as a joint preserving treatment option for osteonecrosis of the hip but has not been described for the ankle. The authors applied free vascularized fibular grafts for 3 cases of avascular necrosis of talus. We observed evidences of revascularization of necrotic talar body and progression of fracture healing and obtained satisfactory results at mean 8 months of follow-up. Vascularized fibular grafting is one of the better alternatives for treating avascular necrosis of talus. It is expected that vascularized fibular grafting can prevent the necrotic talar dome from progressing to collapse and promote directly restored vascularization and new bone formation.

• Hip & pelvis
• /
• v.34 no.3
• /
• pp.172-176
• /
• 2022

A 58-year-old-male patient presented with worsening pain and restricted movements of his right hip after undergoing multiple procedures for treatment of an inter-trochanteric fracture. Secondary arthrosis and an incorporated intramedullary fibular cortical bone graft which caused severe narrowing of the medullary canal were observed by imaging. Total hip arthroplasty (THA) using knee arthroscopic tools was performed for preparation of the severely narrowed femoral canal. A satisfactory clinical outcome was achieved and stable components were observed on radiographs at the 11-year follow-up. The technique described here may be considered when attempting to perform a conversion THA for preparation of a severely narrowed femoral canal using a fibular strut in order to minimize morbidity and prevent structural destabilization.

• Archives of Reconstructive Microsurgery
• /
• v.10 no.1
• /
• pp.18-22
• /
• 2001

Purpose : The purpose of this study was to evaluate stress fracture of vascularized fibular grafts(VFG) by analyzing factors associated with stress fracture and the treatment results. Materials and Methods : From June 1985 to May 1998, 7 patients with stress fractures in the 38 patients with long bone defect who had vascularized fibular graft were evaluated with clinical and radiologic methods including grafted fibular length and hypertrophic index of de Boer. The average age of the patients was 35 years(range, $14{\sim}60$ years). The mean follow-up period was 20 months(range, $16{\sim}32$ months). Results: 7(18.4%) stress fractures occurred in 38 patients. Characteristics of the fractures were (1) all occurred at lower extremity of male patients treated with VFG for long bone defected caused by infected nonunion; (2) all occurred 10 months at the average(range, $4{\sim}17$ months) after VFG; and (3) the length and hypertrophic index of grafted fibula had no influence on the incidence of stress fracture. Union was obtained in 3 patients by conservative treatment. 4 patients obtained union by internal fixation; one at immediately onset of fracture; and three after failure of conservative treatment who had fracture around the knee joint. Conclusion : Stress fracture may occur during the first one year after vascularized fibular graft and more attention must be paid for prevention of it, especially in the cases of infected nonunion. Stress fracture around the knee joint was expected to lead to a good result of early union by operative treatment.

• 대한미세수술학회:학술대회논문집
• /
• 1997.10a
• /
• pp.123.1-123.1
• /
• 1997