IPSILATERAL VASCULARISED FIBULAR TRANSFER FOR RECONSTRUCTION OF OSTEOMYELITIC TIBIAL GAP DEFECTS IN MALAWI

Abstract

Gap defects in the tibial shaft can arise as a consequence of auto-sequestrectomy in chronic osteomyelitis. Whilst bone transport techniques can be utilised to treat defects, the skills and equipment necessary for such procedures are seldom available in the developing world. An alternative, and more freely available method of reconstruction is to use ipsilateral vascularised fibular transfer.

Approach to the fibula is postero-lateral. Muscle attachments to the lateral and antero-medial surfaces of the bone are released but care is taken to maintain the posterior proximal vascular pedicle, arising from the peroneal artery and to keep the periosteum intact. The fibula is then osteotomised proximally and distally and then transposed, by translation and rotation into a pre-prepared graft bed spanning the tibial defect. Some form of fixation and stabilisation may then be required and cancellous bone graft applied.

Over the past 12 months 5 cases of ipsilateral vas-cularised fibular transfer have been performed. Mean age of the patients was 6.4. In three cases stabilisation was by a trans-calcaneal, intramedullary K-wire. In the remainder interfragmentary screws were used at the proximal and distal ends of the graft, supplemented by external fixation. Cancellous bone grafting was only performed in those cases also undergoing external fixation.

In all cases the graft united satisfactorily at both the proximal and distal ends. No further procedures were necessary to effect this union. Particularly in the younger patients compensatory hypertrophy of the fibula, in response to the increased weight-bearing demand, was both marked and rapid. All five cases have completed treatment and need no mobility aids when walking.

In conclusion we feel that the ipsilateral vascular-ised fibular graft is a useful method for treating tibial gap defects of osteomyelitic origin. Few specialised resources are required and thus it is a suitable technique for the developing world.