American Association of Plastic Surgeons

Back to 2018 Program


The Living Intramedullary Nail: A Comparison of Vascularized Free Fibula and Bone Transport for Reconstruction of Intercalary Tibial Defects
Duncan Mackay, MD, MBA, Michael Mirzabeigi, MD, Jaimo Ahn, MD, PhD, Samir Mehta, MD, L. Scott Levin, MD, Stephen Kovach, MD.
University of Pennsylvania, Philadelphia, PA, USA.

PURPOSE: At our institution, reconstruction of critically-sized intercalary tibial defects with soft tissue defects entails soft-tissue-only free flaps over a spacer and subsequent bone transport or vascularized free osteomyocutaneous fibula flap with a Taylor Spatial Frame (TSF). To date, there has not been a direct comparison of these methods.
METHODS: A series of combined intercalary tibial defects reconstructed with osteomyocutaneous free fibula flaps as a spanning, "living intramedullary nail" and TSF was compared to a series of combined intercalary tibial defects repaired with soft-tissue-only free flap with antibiotic impregnated spacer and subsequent bone transport in a ringed external fixator. Free fibula patients were stabilized with standard external fixator at time of index flap and converted to TSF [Fig 1] and allowed full weight bearing to allow for fibula hypertrophy
RESULTS: Patients who underwent fibula flaps were compared with patients who underwent soft-tissue-only flaps and bone transport. Despite having a larger average defect size (9.6cm vs 6.9cm) the free fibula patients had shorter time to weight bearing (43 vs 65 days), fewer operations due to lower complication rate (4.3 vs 7.8), and faster recovery time (289 vs 328 days). The faster recovery time was emphasized when examined relative to defect size (31 vs 47 days per cm defect)
CONCLUSION: Vascularized free fibula with subsequent TSF placement resulted in less need for re-operation than soft-tissue-only free flaps with bone transport. Microsurgical reconstruction with living bone can reduce the time to union, weight bearing, and the need for secondary surgical procedures


Back to 2018 Program