title: Free fibula flap elbow-joint hemiarthroplasty reconstruction for chronic osteomyelitis of the distal humerus.
abstract: The vascularized fibula flap has become a major tool in upper limb reconstruction. Free fibula flap reconstructions of the humeral part of the shoulder and the radial part of the wrist joints are well-documented, but reports of elbow joint reconstruction are rare. The authors report a 53-year-old patient with chronic osteomyelitis of the distal humerus that was unsuccessfully treated by many local surgical debridements and long-term systemic antibiotics. The patient underwent a wide debridement of the distal two-thirds of the humerus, and a spacer was inserted to fill the bony humeral gap. At a second stage, the distal humerus was reconstructed with a free fibula flap that included the proximal fibular head. The fibular shaft was used to bridge the bony gap and the fibular head created an elbow joint with the olecranon process. At an 18-month follow-up after surgery, the patient has stable and sufficient function of his elbow joint with no signs of infection. The free fibula flap has an important role for distal humerus reconstruction, both for bridging the bony gap with a vascularized bone, and for restoring elbow joint function.
authors.affiliation: Microsurgery Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Barnea
authors.forename: Aharon
authors.initials: A
authors.lastname: Amir
authors.forename: Dadia
authors.initials: D
authors.lastname: Shlomo
authors.forename: Nir
authors.initials: N
authors.lastname: Cohen
authors.forename: Arik
authors.initials: A
authors.lastname: Zaretski
authors.forename: David
authors.initials: D
authors.lastname: Leshem
authors.forename: Ehud
authors.initials: E
authors.lastname: Miller
authors.forename: Benny
authors.initials: B
authors.lastname: Meilik
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Kollender
authors.forename: Isaac
authors.initials: I
authors.lastname: Meller
authors.forename: Jacob
authors.initials: J
authors.lastname: Bickels
authors.forename: Eyal
authors.initials: E
authors.lastname: Gur
mesh_terms: D001178:Arthroplasty / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods; D002908:Chronic Disease; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005360:Fibula / Q000637:transplantation*; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D006811:Humerus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000601:surgery*; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply; D016896:Treatment Outcome