title: A solution to the vessel shortage during free vascularized fibular grafting for reconstructing infected bone defects of the femur: Bridging with vein transplantation.
abstract: OBJECTIVE
  The present study aimed to evaluate the feasibility and clinical efficacy of bridging vein transplantation to deal with the vessel shortage during free vascularized fibular grafting for reconstructing infected bone defects of the femur.
  
  
  METHODS
  Twelve patients (aged 15-58 years) with infected bone defects of the femur (between 6.0 and 18.0cm) were recruited in this study. Vacuum sealing drainage were applied after extensive debridement of the infected bone defects and irrigated with 0.9% sodium chloride solution for 1-2 weeks. After the drainage was clear and the focal infections were controlled, the free vascularized fibula was harvested for reconstructing the femoral bone defects. The vascularized fibula was grafted and fixated appropriately at the recipient site. The autogenous great saphenous vein was harvested, one end was anastomosed and bridged the vascular pedicles of the fibular grafts, and the other end anastomosed the artery and/or the vein in the recipient healthy site.
  
  
  RESULTS
  Mean length of vein transplantation with vascularized fibular graft was 10.2 cm (range 7-15cm). All patients had good radiological healing without recorded nonunion or malunion. No patient developed deep infection or implant failure. Primary bone healing was achieved in 10 patients; however, 2 grafted fibular formed pseudarthrosis with the recipient femoral and then healed after a secondary surgery. One patient suffered from graft stress fracture after bone healing and healed after external fixation. After the mean follow-up of 30 months (9-72 months), according to the Enneking scoring system, clinical outcomes were excellent in 7 patients, good in 4 and fair in one. The functional recovery rate of the lesion limb was 89.4%.
  
  
  CONCLUSIONS
  Free vascularized fibular graft with vein transplantation bridged vascular pedicle can effectively repair the infected bone, improve blood supply to the bone defect site, and help control infection. It is a feasible and effective treatment for infected bone defects of the femur with poor soft tissue conditions, or blood supply vessel shortage.
authors.affiliation: Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. Electronic address: doctor020@163.com.
authors.forename: Ren
authors.initials: R
authors.lastname: Gao-Hong
authors.affiliation: Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Li
authors.initials: L
authors.lastname: Run-Guang
authors.affiliation: Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Gui-Yong
authors.affiliation: Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Chao-Jie
authors.affiliation: Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Bao
authors.initials: B
authors.lastname: Zhi-Gang
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China; D003646:Debridement / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005269:Femur / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D005360:Fibula / Q000098:blood supply / Q000637:transplantation*; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome; D014680:Veins / Q000637:transplantation*; D055815:Young Adult
keywords: Bone defect repair; Infected femur bone defect; Orthopedic infection; Vascularized fibular graft; Vessel transplantation