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Wee et al. Plast Aesthet Res 2019;6:12 Plastic and
DOI: 10.20517/2347-9264.2019.02 Aesthetic Research

Original Article Open Access

Reconstruction of extremity long bone defects with

vascularized fibula bone grafts

Corinne Wee , Daniel Ruter , Steven Schulz , Geoffroy Sisk , Julie West , Scott Tintle , Ian Valerio 3
4
3
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2
1
1 Division of Plastic and Reconstructive Surgery in the Department of Surgery, Case Western Reserve University, Cleveland, OH
44106, USA.
2 Division of Plastic and Reconstructive Surgery in the Department of Surgery, Albany Medical College, Albany, NY 12208, USA.
3 Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, OH 43212, USA.
4 Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
Correspondence to: Prof. Ian Valerio, Department of Plastic and Reconstructive Surgery, The Ohio State University, 915
Olentangy River Road, Ste 2100, Columbus, OH 43212, USA. Email: ian.valerio@osumc.edu
How to cite this article: Wee C, Ruter D, Schulz S, Sisk G, West J, Tintle S, Valerio I. Reconstruction of extremity long bone defects
with vascularized fibula bone grafts. Plast Aesthet Res 2019;6:12. http://dx.doi.org/10.20517/2347-9264.2019.02
Received: 6 Jan 2019 First Decision: 17 Apr 2019 Revised: 9 May 2019 Accepted: 30 May 2019 Published: 21 Jun 2019

Science Editor: Dr. Matthew L. Iorio Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Aim: Composite tissue defects encompassing bone and/or isolated bony defects can pose a surgical challenge;
however, their reconstruction is critical for successful functional limb salvage. These cases become increasingly
problematic as secondary defects, following multiple nonvascularized grafting attempts resulting in complex bony
nonunion. Herein, our experience utilizing fibula vascularized bone grafts (VBGs) for bone restoration will be
presented to demonstrate their utility in a variety of reconstructions for limb salvage.

Methods: This is a case series describing a series of vascularized fibula grafts for extremity reconstruction performed
by a single academic surgeon over multiple institutions in seven years.

Results: Twenty-seven (27) total VBGs met inclusion criteria and underwent reconstruction for traumatic (16),
oncologic (6) and chronic degenerative (5) etiologies. Bony union was achieved in 26 of 27 cases.

Conclusion: The decision-making process for bony reconstruction in these scenarios is difficult and multivariable.
Fibula VBGs can provide a single-stage solution for autologous bony and soft tissue replacement of large or complex
bone defects and can often be superior options compared with non-vascularized bone grafts or non-bone internal
fixation techniques. Their osteogenic potential is unmatched by allogenic or synthetic substitutions. These benefits
are evident in a variety of clinical settings such as pediatrics, oncology and trauma.

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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