Fibula Free Flap

Abstract

Bony defects are most often caused by trauma, tumor, infection, or congenital anomaly, and this can lead to poor quality of life and occasionally amputation. Despite the development of newer techniques like bridging endoprostheses and distraction osteogenesis, bone grafts are still used for the management of nonunions and defects to promote healing. Bone grafts have been used in reconstructive surgery for a century and recent advances in microvascular techniques have made free fibula flap transfer a viable option for reconstruction of long bone defects.[1][2] In 1975, Taylor et al transferred the first free fibula through the posterior approach and the technique was further improved by Gilbert who described the lateral approach, which was later evolved by Chuang et al, who popularized the osteomyocutaneous fibular flap.[3][4] In 1994, Hidalgo further expanded indications for fibular free tissue transfer by describing osteotomy techniques that permit shaping the fibula to mimic that of the mandible, making the fibula the workhorse for head and neck reconstruction that it is today.[5] There are many ways of employing fibular bone for reconstruction: cancellous and cortical autografts, bone allografts, endoprosthetic replacement, vascularized bone grafts, fibular osteocutaneous flaps, and fibular osteomuscular flaps.[6][7][8] Among these options, free vascularized fibular graft is unique in that it provides immediate mechanical support but it also can grow or hypertrophy depending on the patient's situation.[9] Vascularized fibular grafting is not a solution in all cases that require bony reconstruction; however, it is a frequently-used option for bony defects >6 cm, failed conventional bone grafting, infected nonunion with a bony defect, or following tumor resection, particularly when postoperative radiation therapy is planned.