Ipsilateral vascularised fibular transport for massive defects of the tibia

The ipsilateral and contralateral fibulae have been used as a vascularised bone graft for loss of tibial bone usually by methods which have involved s pecialised microvascular techniques to preserve or re-establish the blood s upply. We have developed a method of tibialisation of the fibula using the Ilizaro v fixator system, ipsilateral vascularised fibular transport (IVFT), and ha ve used it in five patients with massive loss of tibial bone after treatmen t of an open fracture, infected nonunion or chronic osteomyelitis, All had successful transport, proximal and distal union, and hypertrophy of the gra ft without fracture. One developed a squamous-cell carcinoma which ultimate ly required amputation of the limb. The advantage of IVFT is that the fibular segment retains its vascularity w ithout the need for microvascular dissection or anastomoses. Superiosteal f ormation of new bone occurs if the tibial periosteal bed is retained. Other procedures such as corticotomy and lengthening can be carried out concurre ntly.