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Wee et al. Plast Aesthet Res 2019;6:12 I http://dx.doi.org/10.20517/2347-9264.2019.02 Page 9 of 12

Figure 11. Radiograph demonstrating open both-bone forearm fracture

Figure 12. Osteocutaneous reconstruction with free fibula

Case 10. A 52-year-old male presented with hardware infection after his original distal tibia fracture was
treated with plate fixation [Figure 14]. After necessary debridement, he was left with a segmental tibial and
associated soft tissue defect. The ends of a free fibula graft were telescoped into the proximal and distal tibia
and immediate stability was achieved. Small plates were utilized to ensure adequate fixation and a circular
frame was then applied allowing for nearly immediate weight-bearing [Figure 15].

DISCUSSION
The decision-making process for reconstruction of segmental bone defects and osseous nonunion can
be complex and multivariable. A multidisciplinary orthoplastic approach is recommended for optimal
outcomes. Clear communication of reconstructive goals and options should be discussed among the
orthoplastic surgery team. These goals should align with reconstructive goals, rehabilitation potential, and
wound healing reserve of the patient at hand. In this illustrative case series, we sought to explore the utility
and versatility of fibula vascularized bone grafts in reconstructing complicated bony defects and achieving
bone union.

We found fibula VBGs to be an excellent method for single-stage bony reconstruction in patients with
bony defects complicated by numerous factors, especially in cases with previously failed reconstruction.