title: Free vascularized fibular grafts have a high union rate in atrophic nonunions.
abstract: Free vascularized fibular grafting currently is an extremely useful tool in the armamentarium of the orthopaedic, reconstructive surgeon. Certain problematic nonunions, aseptic or infected, have to be treated by vascularized bone grafts when previous operations are not successful. The common characteristics of these nonunions are several previous operations and fixations, bone atrophy and damage of the surrounding soft tissue, and frequently focal, active infection. After the bone and soft tissue debridement, the bony defect is bridged by a vascularized fibula strut. Depending on the recipient bone, different methods of internal fixation can be used, usually plates and external fixators. Free vascularized fibular grafts in recalcitrant, atrophic nonunions provide a high success rate. According to the results, this is a safe, reliable method that is indicated when a fracture does not heal after several surgeries, when there is an associated bone lost, and when infection is present.
authors.affiliation: Institute of the Hand, Wrist and Reconstructive Microsurgery, Madrid, Spain. jgpino@telefonica.net
authors.forename: Juan
authors.initials: J
authors.lastname: González del Pino
authors.forename: Emilio
authors.initials: E
authors.lastname: Bartolomé del Valle
authors.forename: Gabriel López
authors.initials: GL
authors.lastname: Graña
authors.forename: Javier Ferreira
authors.initials: JF
authors.lastname: Villanova
mesh_terms: D000328:Adult; D000368:Aged; D001134:Arm Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D001284:Atrophy; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005360:Fibula / Q000098:blood supply* / Q000637:transplantation*; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D010012:Osteogenesis / Q000502:physiology; D011859:Radiography; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016896:Treatment Outcome