Wrist Arthrodesis with Vascularized Fibular Graft after Failed Allograft Replacement for Giant-Cell Tumor Resection

Giant-cell tumor (GCT) is locally aggressive bone neoplasm, with an unpredictable pattern of biological aggressiveness. The optimal treatment had to achieve a negligible local recurrence rate while maximizing musculoskeletal function. Numerous options for reconstruction are available, but in the literature there is a lack of salvage surgery data. We present a case of a 67-year-old woman who underwent complete wrist arthrodesis with vascularized fibular graft as salvage procedure for allograft necrosis, after excision of a distal radius GCT. The patient did not complain of any impairment in daily use, and the functional score was 22 points (73%) at latest follow-up of 14 months. Despite joint salvage remains the most favorable treatment with regard to functional outcome for aggressive tumors of the distal radius, vascularized fibular grafts is a valuable alternative especially in salvage procedures, where the use of another allograft could lead to higher complications rate. Keywords: Vascularized fibular graft, Wrist arthrodesis, Giant-Cell Tumor, Fibula free flap.

Free Vascularized Fibular Graft for Congenital Pseudarthrosis Tibia: A Case Series

Introduction: Congenital pseudarthrosis tibia (CPT) probably one of the most difficult to treat among all diseases in the children. There are several surgical approaches that have been used to treat CPT including on-lay graft, double on-lay grafts, pedicle grafts, osteotomy, bypass graft and intramedullary rods. Prognosis of CPT has changed considerably with the use of Free Vascularized Fibular Graft (FVFG). Despite these advances, several operations are often necessary to obtain union of CPT and the risk of amputation is never entirely eliminated Case presentation: We presented 2 case with CPT. The first case is a 4 year old girl with CPT-Associated Neurofibromatosis, patient was brought to orthopedic polyclinic complaining bend on her right leg since she was born, the parent also complained her child has abnormality when walking since she was 14 months old. The second case is a 3 year old girl with CPT complaining bend on her right leg, abnormalities and pain when walking since she was aged 1 years 11 months. We performed free vascularized fibular graft for both of the patient. Result: The results in our cases showed bone union in 14 weeks, 16 weeks and 18 weeks respectively. The optimal of technique options should be adapted to the type of pseudarthrosis and especially to the extent of the bone defects. good results can be found with intramedullary nailing with a bone graft or the Ilizarov technique Conclusion: The optimal of technique options should be adapted to the type of pseudarthrosis and especially to the extent of the bone defects Keywords: Congenital pseudarthrosis tibia, Free vascularized fibular graft, case series.

Free Vascularized Fibular Graft

Background: Free Vascularized Fibular Grafts (FVFGs) are currently a mainstay for extreme case reconstruction mainly due to their anatomical characteristics, reliability, and versatility in managing all bone defects cases. Method: This paper is a review article of the journal found by the author suitable for our reference in search engines with the keywords "Free Vascularized Fibular Graft" "surgery" "postoperative" and "complications". Results: FVFG can be used as management of bone defects such as post-trauma, infection or tumor, treatment of congenital abnormalities, avascular necrosis (AVN), arthrodesis, and pediatric pathology. Position Placement, Intercalary Resection, Bone Tumor Resection, Fibula Flap Retrieval, Allograft Preparation, Reconstruction at Recipient Site, and Intra-articular Resection need to be considered in the surgical procedure. Postoperative Monitoring in the ICU is necessary to evaluate Vital signs, flap viability, axle well as complications in patients. Conclusion: FVFG is a choice of bone defect reconstruction techniques with good results to be considered by orthopedic surgeons. Keywords: Free Vascularized Fibular Grafts, FVFG, Surgery post-operative, complication.

Massive Ameloblastoma and Reconstruction with Free Fibular Graft

Aims: To report a case of massive ameloblastoma in mandible with wide excision and reconstruction with free vascularized fibular graft and titanium plate. Case Description: A 49- year-old male patient complained right facial mass since 5 years ago. Patient underwent right hemimandibulectomy with general anesthesia and pathologic examination revealed folliculare ameloblastoma. The large defect after resection reconstructed with free fibular graft. Fibula was osteotomised and resembled with mandible shape and reconstructed by plate with intact pedicle. Care was taken to protect the periosteal branch of the peroneal artery before performing an osteotomy. Shaping of the resected fibula was done according to the preoperative template. A titanium miniplate with locking screws was used to secure the osteotomized fibula and the mandible. To secure the airway, we performed tracheostomy. Followup after operation, patient still got a defect facial asymmetry in right mandible. Discussion: Ameloblastoma is histologically benign but locally aggressive tumor originating from odontogenic epithelium. After hemimandibulectomy, reconstruction continued with microvascular free fibular graft and titanium plate. Osteotomies were performed with the pedicle still attached. Conclusions: Free vascularized fibular graft with titanium plate is preferrably reconstruction option for large defect after wide excision of mandibular ameloblastoma.

Anterior Fusion using a Vascularized Fibular Graft for Cervical Kyphosis Associated with Neurofibromatosis Type 1: A Report of Two Cases with Long-term Follow-up

Introduction: Vascularized fibular grafts (VFG) in the cervicothoracic spine have been used for patients with progressive neurofibromatosis (NF) type-1-related kyphosis, but the long-term outcomes of VFG with NF-1 are not well described. We describe the long-term follow-up of two cases of cervical kyphosis related to NF-1 treated with VFG in the cervical spine. Case Report: Case 1 was that of a 33-year-old man with a large neurofibroma at the back of his neck and an arteriovenous malformation at C2–7. The neurofibroma was resected by durotomy and intradural neurofibromas were extirpated through O-C6 laminectomy. Anterior fusion with VFG was performed 6 months later, and bone union was confirmed after 4 months. Cervical alignment was maintained with 50° kyphosis 15 years after the operation. The man suffered a subarachnoid hemorrhage 22 years after the operation. Case 2 was a 23-year-old woman with diastematomyelia at C6–T1 who was treated by anterior fusion with VFG at C4–T1. The diastematomyelia septum was resected through a C4–T1 laminectomy with simultaneous posterolateral fusion at C3–T2. Cervical alignment was maintained with 50° kyphosis 18 years later. The left vertebral artery ruptured and was embolized 10 years after the operation. Conclusion: Anterior fusion with VFG can achieve good bone union and maintains long-term alignment. However, it is important to watch for vascular events related to NF-1. Keywords: Vascularized fibular graft, cervical kyphosis, neurofibromatosis type 1.