Vascularised free fibular bone grafting in reconstruction of infectious bone defects after surgery for proximal and distal femoral fractures
10.3760/cma.j.cn441206-20240424-00105
- VernacularTitle:吻合血管游离腓骨移植修复股骨近端及远端骨折术后感染性骨缺损
- Author:
Abula ABULAITI
1
;
Kai LIU
;
Peng REN
;
Chuang MA
;
Abulaiti ALIMUJIANG
;
Yusufu AIHEMAITIJIANG
Author Information
1. 新疆医科大学第一附属医院骨科中心显微修复外科，乌鲁木齐 830054
- Keywords:
Femur;
Fracture-related infection;
Bone defect;
Fibula transfer
- From:
Chinese Journal of Microsurgery
2024;47(5):544-548
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical effect of vascularised free fibula transfer in the treatment of infectious bone defects after the surgery of proximal and distal femoral fractures.Methods:The clinical data of 27 patients with femoral bone defects treated by vascularised free fibulae grafting with fibular artery and vein as pedicle from December 2010 to December 2022 were retrospectively analysed in the Department of Trauma and Microreconstructive Surgery, the First Affiliated Hospital of Xinjiang Medical University. There were 21 males and 6 females, at 17-72 years old, with a mean age of 41.7 years old. Twenty-one patients had bone defect of right femurs and 6 of left femurs. The length of bone defect ranged from 5.0 cm to 9.0 cm, with an average of 6.6 cm. The length of transferred fibulae ranged from 5.0 cm to 14.0 cm, with an average of 6.8 cm. Donor sites were carefully sutured layer by layer, and standardised antibiotic therapy was given before and after surgery. X-ray reviews of the affected limbs were taken at 1, 3, 6, 12, 18 and 24 months after surgery to observe the healing of the transferred fibulae and femurs to evaluate the time for full weight-bearing and removal of external frames. Before discharge, the patients were instructed to carry out pin tract care for prevention of infection. The psychological status of the patients was monitored at outpatient clinic or telephone interviews, and the functional recovery of the affected limbs was assessed using the Enneking lower limb function scoring system.Results:All of 27 patients were included in the postoperative follow-up from 19 months to 34 months, with a mean time of 26.1 months. The transferred fibulae survived with bone union. The bone healing time was from 5.1 months to 8.8 months, with an average of 7.1 months. Twenty-five patients had primary healing of the recipient site wound, and 2 patients had a sinus formed at the orifice of drainage with secretion, and the results of bacterial culture were negative. The sinuses healed after cleaning and dressing change at outpatient clinic. No stress fracture was observed from the transferred fibulae in all patients, as well as no recurrence of infection at recipient sites. The Enneking lower limb function score at the final follow-up ranged from 22 points to 27 points, with an average of 23.7 points.Conclusion:Anastomosis of vascularised free fibula in bone transfer is a feasible method to reconstruct the infected bone defects after proximal and distal femoral fractures. It provides reliable fixation and satisfactory bone healing for bone defects and facilitates the healing of transferred fibula and the recovery of lower limb function.
