Free Fibula Flap Elbow-Joint Hemiarthroplasty Reconstruction for Chronic Osteomyelitis of the Distal Humerus

 

 Buy Article Permissions and Reprints

ABSTRACT

The vascularized fibula flap has become a major tool in upper limb reconstruction. Free fibula flap reconstructions of the humeral part of the shoulder and the radial part of the wrist joints are well-documented, but reports of elbow joint reconstruction are rare.

The authors report a 53-year-old patient with chronic osteomyelitis of the distal humerus that was unsuccessfully treated by many local surgical debridements and long-term systemic antibiotics. The patient underwent a wide debridement of the distal two-thirds of the humerus, and a spacer was inserted to fill the bony humeral gap. At a second stage, the distal humerus was reconstructed with a free fibula flap that included the proximal fibular head. The fibular shaft was used to bridge the bony gap and the fibular head created an elbow joint with the olecranon process. At an 18-month follow-up after surgery, the patient has stable and sufficient function of his elbow joint with no signs of infection.

The free fibula flap has an important role for distal humerus reconstruction, both for bridging the bony gap with a vascularized bone, and for restoring elbow joint function.

REFERENCES

• 1 Taylor G I, Miller G D, Ham F J. The free vascularized bone graft. A clinical extension of microvascular technique.  Plast Reconst Surg. 1975;  55 533-544
  Google Scholar
• 2 Kumta S M, Leung P C, Yip K, Hung L K, Panozzo A, Kew J. Vascularized bone grafts in the treatment of juxta-articular giant-cell tumors of the bone.  J Reconstr Microsurg. 1998;  14 185-190
  PubMedGoogle Scholar
• 3 Gao Y H, Ketch L L, Eladoumikdachi, Netscher D T. Upper limb salvage with microvascular bone transfer for major long-bone segmental tumor resection.  Ann Plast Surg. 2001;  47 240-246
  PubMedGoogle Scholar
• 4 Wada T, Usui M, Isu K, Yamawakii S, Ishii S. Reconstruction and limb salvage after resection for malignant bone tumors of the proximal humerus. A sling procedure using a free vascularized fibula graft.  J Bone Joint Surg Br. 1999;  81 808-813
  CrossrefPubMedGoogle Scholar
• 5 Gerwin M, Weiland A J. Vascularized bone grafts to the upper extremity.  Indications and techniques. Hand Clin. 1992;  8 509-523
  PubMedGoogle Scholar
• 6 Minami A, Kutsumi K, Takeda N, Kaneda K. Vascularized fibular graft for bone reconstruction of the extremities after tumor resection in limb-saving procedures.  Microsurgery. 1995;  16 56-64
  CrossrefPubMedGoogle Scholar
• 7 Usui M, Murakami T, Naito T, Wada T, Takahashi T, Ishii S. Some problems in wrist reconstruction after tumor resection with vascularized fibular-head graft.  J Reconstr Microsurg. 1996;  12 81-88
  PubMedGoogle Scholar
• 8 Dautel G, Duteille F, Merle M. Use of osteocutaneous “double-barrel fibular flaps” in limb reconstruction: four clinical cases.  Microsurgery. 2001;  21 340-344
  CrossrefPubMedGoogle Scholar
• 9 Manfrini M, Innocenti M, Ceruso M, Mercuri M. Original biological reconstruction of the hip in a 4-year-old girl.  Lancet. 2003;  361 140-142
  CrossrefPubMedGoogle Scholar
• 10 Kimura K, Tatezaki S, Ishii T, Yonemoto T, Shigehara T, Takenouchi T. Hemiarthroplasty of the elbow with a vascularized fibular graft after excision of Ewing's sarcoma of the proximal ulna: a case report.  Jpn J Clin Oncol. 2002;  32 430-434
  CrossrefPubMedGoogle Scholar
• 11 Yajima H, Tamai S, Ono H, Kizaki K. Vascularized bone grafts to the upper extremities.  Plast Reconstr Surg. 1998;  101 727-735
  CrossrefPubMedGoogle Scholar
• 12 Heitmann C, Erdmann D, Levin L S. Treatment of segmental defects of the humerus with an osteoseptocutaneous fibular transplant.  J Bone Joint Surg Am. 2002;  84 2216-2223
  CrossrefPubMedGoogle Scholar
• 13 Jupiter J B, Gerhard J H, Guerrero J, Nunley J A, Levin S L. Treatment of segmental defects of the radius with use of the vascularized osteoseptocutaneous fibular autogenous graft.  J Bone Joint Surg Am. 1997;  79 542-550
  PubMedGoogle Scholar
• 14 Gianoutsos M P, Marsden F W, McCarthy S W, Lee K K. Ulnar adamatinoma: en bloc excision and fibular osteoseptocutaneous flap reconstruction.  J Hand Surg Am. 1994;  19 495-499
  PubMedGoogle Scholar
• 15 Guelinckx P J, Sinsel N K. Refinements in the one-stage procedure for management of chronic osteomyelitis.  Microsurgery. 1995;  16 606-611
  PubMedGoogle Scholar
• 16 Weiland A J. Current concepts review: vascularized free bone transplants.  J Bone Joint Surg Am. 1981;  63 166-169
  CrossrefPubMedGoogle Scholar
• 17 Sperling J W, Pritchard D J, Morrey B F. Total elbow arthroplasty after resection of tumors at the elbow.  Clin Orthop. 1999;  367 256-261
  PubMedGoogle Scholar

Eyal GurM.D. 

The Department of Plastic Surgery, The Tel-Aviv Souraski Medical Center

6 Weizman Street, Tel-Aviv 64239, Israel