2012 Volume 25 Issue 2 Pages 109-112
To accomplish free vascularized tissue transfer, both arterial and venous anastomosis between recipient vessels and nutrient vessels of the grafts are usually necessary. We have successfully performed free vascularized fibular grafting in spite of failure of venous anastomosis in 2 patients. In the 2 patients, vascularized fibula with a skin flap was grafted to segmental bony defects of the contralateral tibia in an inlay fashion. Venous thrombosis at the anastomosis site occurred repeatedly in each patient after the surgery, and venous drainage was abandoned. The skin flaps were congested, but the flaps and fibulas survived. Postoperative radiographs demonstrated bone union and hypertrophy of the grafted fibulas. It can be presumed that venous drainage of the grafted fibula occurred by intraosseous circulation of the tibia at the recipient site. The results suggest that vascularized fibular grafting can be accomplished with only arterial anastomosis when intraosseous venous drainage occurs at the recipient site.
