[The folded fibula flap: anatomical study and clinical application to septic post-traumatic femoral reconstruction. A propos of 6 cases].
The reconstruction of extensive femoral defects, particularly septic, by revascularized free fibula flap has become part of routine practice for many years. Following the demonstration of secondary stress fractures, splitting of the fibula into two vascularized barrels was proposed in 1987 to avoid this complication. The authors conducted an anatomical study on 100 dry bones in order to define the situation of the fibular foramen which is usually found at about 1.45 cm from the midpoint of the fibula. This foramen must be spared during the intermediate splitting osteotomy in order to obtain two bone barrels: one with a double centromedullary and periosteal blood supply which will be used like a contromedullary pin, and the other with only a periosteal blood supply, which will be used as a medial or lateral splint. The deductions concerning the preoperative strategy and splitting technique are explained as a function of the length of the defect. From 1989 to 1993, 6 male patients underwent extensive femoral reconstruction (average length of 9.8 cm). Four free revascularized transfers were performed, including one osteocutaneous flap. In two cases, the osteocutaneous transfer was a proximally based island pedicle flap. Apart from one patient who was subsequently amputated, five patients underwent a secondary autologous bone graft after an average of three months. Consolidation was achieved after a mean of 12.6 months. A secondary stress fracture was observed in one case. With a minimum follow-up of two years, all patients are able to walk with a mean shortening of 2 cm of the reconstructed limb and without any donor site sequelae.
Cariou
J L
JL
Service de Chirurgie Plastique, Chirurgie Maxillo-Faciale et Stomatologie, Hopital d'instruction des Armées Begin, Saint-Mande.
Couturaud
B
B
Tripon
P
P
Lambert
F
F
Bellavoir
A
A
D000328:Adult; D005264:Femoral Fractures / Q000601:surgery*; D005360:Fibula / Q000098:blood supply / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D013524:Surgical Flaps
Le lambeau dédoublé de fibula: étude anatomique et application clinique a la reconstruction fémorale post-traumatique septique. A propos de six cas.