OBJECITVE: To investigate the effectiveness of three-dimensional (3D) printing-assisted vascularized fibular graft for repairing metatarsal defects. METHODS: Between November 2021 and February 2024, 11 patients with varying degrees of metatarsal defects caused by trauma were treated. There were 10 males and 1 female, aged 22-67 years, with a mean age of 51.2 years. The defect locations were as follows: the first metatarsal in 4 cases, the fifth metatarsal in 2 cases, the first and the second metatarsals in 1 case, the first to third metatarsals in 1 case, the third and the fourth metatarsals in 1 case, the third to fifth metatarsals in 1 case, and the first to fifth metatarsals in 1 case. The preoperative American Orthopaedic Foot & Ankle Society (AOFAS) score was 67.0 (48.5, 72.5). Based on 3D-printed bilateral feet models and mirrored healthy-side foot arch angles for preoperative planning and design, the vascularized fibular graft was performed to repair the metatarsal defects. At last follow-up, the medial and lateral longitudinal arches of bilateral feet were measured on weight-bearing X-ray films, and functional assessment was conducted using the AOFAS score. RESULTS: All operations were successfully completed, with an operation time ranging from 180 to 465 minutes (mean, 246.8 minutes). All incisions healed by first intention, with no occurrence of osteomyelitis. All patients were followed up 6-22 months (mean, 10 months). X-ray film reviews showed bone graft healing in all cases, with a healing time of 3-6 months (mean, 5 months). All patients underwent internal fixator removal at 6-12 months after operation. At last follow-up, no significant difference was observed in the medial and lateral longitudinal arches between the healthy and affected feet ( P>0.05). The AOFAS score of the affected foot was 78.0 (73.5, 84.0), showing a significant improvement compared to the preoperative score ( P<0.05). The effectiveness was rated as excellent in 1 case, good in 7 cases, fair in 2 cases, and poor in 1 case. Linear scarring remained at the donor site, with no functional impairment in adjacent joint movement. CONCLUSION 3D printing-assisted vascularized fibular graft for repairing metatarsal defects can effectively restore the physiological angle of the foot arch, facilitate the recovery of weight-bearing alignment, promote good bone healing, and yield satisfactory clinical outcomes.
Humans ; Printing, Three-Dimensional ; Middle Aged ; Male ; Fibula/blood supply* ; Female ; Metatarsal Bones/injuries* ; Adult ; Bone Transplantation/methods* ; Aged ; Plastic Surgery Procedures/methods* ; Young Adult ; Treatment Outcome

OBJECTIVETo investigate the therapeutic effect of V-Y advanced flap pedicled with perforator of peroneal artery at posterior lateral malleolus for small skin defect on children heel.

METHODSFrom Mar. 2012 to Jan. 2014, 9 children with small skin defects on heel were treated with adjacent V-Y advanced flap pedicled with perforator of peroneal artery at posterior lateral malleolus. The flaps were 8.0 cm x 4.0 cm to 9.0 cm x 4.5 cm in size and the wounds at donor sits were directly closed.

RESULTSAll flaps survived completely with primary healing. 9 cases were followed up for 6-12 months( average, 9 months). The flaps had good match with surrounding tissue in texture and color. The function of ankle was normal. All the parents were satisfied with functional and cosmetic results.

CONCLUSIONSIt is a safe and practical method for treatment of small skin defect on children heel with adjacent V-Y advanced flap pedicled with perforator of peroneal artery at posterior lateral malleolus.

Ankle ; Child ; Fibula ; Heel ; injuries ; Humans ; Perforator Flap ; blood supply ; transplantation ; Reconstructive Surgical Procedures ; Skin ; injuries ; Skin Transplantation ; Tibial Arteries ; Wound Healing

OBJECTIVETo investigate the applied anatomy of the superficial peroneal artery perforator flap and report the clinical results of repairing the soft tissue defects with free perforator flaps.

METHODS15 fresh cadavers were injected with a modified lead oxide-gelatin mixture for three-dimensional visualization reconstruction using a 16-slice spiral computed tomography scanner and specialized software (Materiaise's interactive medical image control system, MIMICS). The origin, course and distribution of the superficial peroneal artery perforator in the anterolateral leg region were observed. Clinically 6 cases with hand defects and 6 cases with feet defects were treated with free superficial peroneal artery perforator flap transplantation. The defect size ranged from 3.0 cm x 4.5 cm to 5.0 cm x 11.0 cm.

RESULTSThe diameter of the superficial peroneal artery is (1.2 +/- 0.3) mm at its origin from the anterior tibial artery 5 cm below the fibula head. It is (5.6 +/- 1.8) cm in length. This artery is truly anastomosed with other perforators to form the chain of superficial peroneal nerve accessory artery. The superficial peroneal artery perforators [outer diameter (0.7 +/- 0.2) mm] with a vein are in the anterolateral leg region, supplying the skin in proximal-middle region. All the 12 cases were treated successfully. The clinical results were satisfactory after 3-12 months of following-up.

CONCLUSIONSThe superficial peroneal artery perforator flap has constantly, reliable blood supply, and good texture. It is a good option for repairing soft-tissue defect with free transfer.

Cadaver ; Fibula ; Foot ; Foot Injuries ; surgery ; Free Tissue Flaps ; blood supply ; innervation ; transplantation ; Hand Injuries ; surgery ; Humans ; Leg ; Perforator Flap ; blood supply ; innervation ; transplantation ; Peroneal Nerve ; Soft Tissue Injuries ; surgery ; Tibial Arteries

OBJECTIVETo study the methods and effects of the reconstruction of tumor-induced bone defects with vascularized fibula graft.

METHODSFrom Oct. 1996 to Jan. 2005, 89 patients with bone defects were treated with fibula graft using different methods. Among the patients, 48 patients were male and 41 patients were female, ranging in age from 12 to 67 years, with an average of 35 years. Thirty-five patients were treated with inlay bone grafting after excision of focus, 15 patients were treated with single or double-strut fibula graft after tumor resection, 16 patients were treated with fibular head graft for juxta articular tumor resection, and 23 patients were treated with double-strut fibula combined with iliac graft after marginally resection.

RESULTSEnneking evaluation system was used to evaluate therapeutic effects. Among 35 patients treated with inlay bone graft after excision, 29 patients were followed up, and 26 patients got an excellent result, 1 good and 2 poor. Among 15 patients treated with single or double-strut fibula graft after tumor resection, 12 patients were followed up, and 8 patients got an excellent result, 1 good, 1 poor and 2 bad. Among 16 patients treated with fibular head graft for juxta articular tumor resection, 12 patients were followed up, and 7 patients got an excellent result, 3 good,1 poor and 1 bad. Among 23 patients treated with double-strut fibula combined with iliac graft after marginally resection, 17 patients were followed up, and 11 got an excellent result, 3 good, 1 fair and 2 bad.

CONCLUSIONThese treatment methods can greatly enrich the treatment methods for bone tumor, and satisfy the reconstruction after bone tumor excision in different position of the four limbs. These methods are reliable and can be chosen according to disease types.

Adolescent ; Adult ; Aged ; Bone Neoplasms ; surgery ; Bone Transplantation ; methods ; Child ; Female ; Fibula ; blood supply ; transplantation ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the clinical result of the treatment of old femoral neck fracture and nonunion with free vascularized fibular grafting.

METHODSFrom November 2000 to December 2005, 29 cases with old femoral neck fracture and nonunion had been treated by free vascularized fibular grafting with an average follow-up of 28.5 months.

RESULTSAll the fracture were healed without any severe complications. And the healing time was 4-6 months (5.6 months on average). During the follow-up, the hips of 28 cases got well-function, and the average Harris hip score was 88.2. One case came about with osteonecrosis of femoral head after one year and finally accepted THA after 2 years.

CONCLUSIONSThe free vascularized fibular grafting is a valuable procedure to treat old femoral neck fracture and nonunion.

Adult ; Bone Transplantation ; methods ; Female ; Femoral Neck Fractures ; surgery ; Fibula ; blood supply ; transplantation ; Follow-Up Studies ; Fractures, Ununited ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo study the applied anatomy of the vascular and muscular innervations related to vascularized fibular grafts.

METHODSThirty-four cadaveric lower extremities were dissected for this study. The observations included fibular length, fibular nutrient artery, arcuate arteries, and innervation of fibular muscles. The fibulas were averagely divided into four segments and the locations of relevant vessels and nerves were ascertained.

RESULTSAll specimens had 1 fibular nutrient artery and 4-9 arcuate arteries except 1 specimen which had only 1 arcuate artery. The fibular nutrient artery and the first three arcuate arteries were constantly located between the distal half of the 1/4 segment and 2/4 segment of the fibula. The muscular branch of the superficial peroneal nerve passed through the surface of the periosteum in the 2/4 segment of the fibula.

CONCLUSIONSThe most proximal osteotomy point locates at the midpoint of the 1/4 segment by which it ensure the maximal potential for preserving the nutrient vessels. The muscular branch of the superficial peroneal nerve is fragile to injury at the 2/4 segment of the fibula.

Cadaver ; Female ; Fibula ; blood supply ; innervation ; Humans ; Male

OBJECTIVETo exploit computer-aided design and computer-aided manufactured (CAD/CAM) techniques and application in the reconstruction of mandible large-scale defect with vascularized fibular bone graft.

METHODSBefore actually performing surgery, three-dimensional(3D) computed tomography(CT) was performed in 7 patients with mandibular large-scale defects, and 3D CT images were acquired by processing CT data. Then the CT data were transformed into a readable format and transferred to produce facsimile models by means of using rapid prototyping(RP) techniques. When individual mandibular models and enantiomorphous models were produced, evaluation and surgical simulation was performed in model, which included measuring range of mandible lesions, prefabrication of mandibular reconstructive titanium palate, precise position of titanium screws, shaping the free vascularized fibula by mandibular, etc. According to the simulations, the mandible reconstructions were finished in operation.

RESULTCAD/CAM techniques and application can distinctly display the mandibular lesions and ambient relationships, which is very useful for clinical assessment and surgical planning. Particular advantages were the unlimited trials with the imaging method, and the feeling of reality with the model method. The actual operative time was shortened, and surgery results were satisfactory with few complications.

CONCLUSIONCAD/CAM techniques are very helpful for simulation of mandible large-scale defect with complicated anatomical and reconstructive problems. By preoperative simulation of procedures, surgeons can improve or refine treatment planning using this method and improve postoperative results.

Adult ; Ameloblastoma ; surgery ; Computer-Aided Design ; Female ; Fibula ; blood supply ; transplantation ; Humans ; Imaging, Three-Dimensional ; methods ; Male ; Mandible ; surgery ; Mandibular Neoplasms ; surgery ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Reproducibility of Results

OBJECTIVETo explore the application of computed tomographic angiography (CTA) and computer aided design\manufacture (CAD\CAM) techniques in mandible reconstruction with free fibula flap.

METHODS7 cases of complex mandible defect were reconstructed with free fibula flap. Patients' lower extremity vasculature was evaluated by preoperative CTA examination; mandible tumor resection and reconstruction were simulated by CAD technique, the surgical template was manufactured with CAM technique preoperatively; and fibula flap was shaped according to surgical template during mandible reconstruction operation.

RESULTSPreoperative CTA examination performed without complication, the desired anatomy was adequately demonstrated in all patients. All of flaps survived, patients' facial contour are symmetry approximately.

CONCLUSIONSCTA and CAD\CAM techniques have important value for complex mandible reconstruction in selection of donor site, planning of operation and shaping of fibula flap.

Adolescent ; Adult ; Bone Transplantation ; methods ; Female ; Fibula ; blood supply ; transplantation ; Humans ; Male ; Mandible ; surgery ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; blood supply ; Young Adult

OBJECTIVETo investigate the changes of vascularized fibular bone height after transplantation for mandibular reconstruction.

METHODSThirty-two patients with mandibular defects were reconstructed with vascularized fibular bone. Postoperative follow-up pantomography was used to evaluate the changes of bone height.

RESULTSAt different distance from the vessel pedicles, the changes of bone height showed no significant difference. The height of fibular bone decreased gradually with time and reduced by 6.64% at 1 year postoperatively.

CONCLUSIONSMultiple segmental osteotomies had no effect on blood flow and the different pieces of graft after modeling by osteotomy experienced the similar reconstruction. The volume of grafted fibular bone almost remained stable.

Adolescent ; Adult ; Aged ; Bone Remodeling ; Bone Transplantation ; Child ; Female ; Fibula ; anatomy & histology ; blood supply ; transplantation ; Follow-Up Studies ; Humans ; Male ; Mandible ; pathology ; surgery ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; blood supply ; Young Adult

OBJECTIVETo study the effect of vascularized fibular graft on large defects of long bones and the monitoring method for the vascular status of the grafted fibula.

METHODSFrom March 1988 to February 1998, 30 patients with long bone defects over 6 cm in length received vascularized fibular graft including a monitoring island flap in our department to monitor the blood circulation of the fibulae.

RESULTSMonitoring island abnormalities were indicated in 6 flaps, which accurately gave the alarm of the circulation crisis of the fibular graft. Surgical exploration was performed timely and the blood supply was recovered instantaneously. All the bone defects were healed at 6 months postoperatively. After 4 years of follow-up, all the grafted fibulae were thickened and were just like tibiae.

CONCLUSIONSA monitoring island flap is a satisfactory method for repairing large defects of the long bones and a reliable method for assessing the vascular status of the grafted fibulae.

Adolescent ; Adult ; Anastomosis, Surgical ; Bone Transplantation ; methods ; Child ; Child, Preschool ; Female ; Fibula ; blood supply ; transplantation ; Humans ; Male ; Middle Aged ; Surgical Flaps ; Treatment Outcome ; Wound Healing