TREATMENT OF TIBIAL DEFECTS AND NONUNIONS USING IPSILATERAL VASCULARIZED FIBULAR TRANSPOSITION

Eight patients had nine ipsilateral vascularized fibular transposition s (IVFTs) in the period 19781987. The procedure, which involves no mic rovascular anastomosis, was done for difficult problems of the tibia i ncluding two long-standing posttraumatic nonunions, three allograft no nunions after tumor surgery, and four segmental tibial defects also af ter tumor surgery. The average duration of problems before surgery was 3.5 years, and the patients averaged 3.1 procedures before IVFT. The patients were followed for an average of 52.4 months. The average time to union was 4.2 months, and in all patients the grafts healed within six months. Late fracture of the graft developed in two patients afte r fixation removal; one required an additional procedure, and both eve ntually healed. Ipsilateral vascularized fibular grafting is a useful alternative to conventional, nonvascularized grafts for difficult tibi al nonunions and segmental defects. It offers the advantages of a vasc ularized graft (early healing and hypertrophy), yet avoids the time-co nsuming microvascular anastomosis and distant donor site morbidity of free fibular grafts.