Pedicled Vascularized Fibula Graft through a Posterior Approach for Reconstruction of Tibial Non-union: A Case Report

Abstract

In the following report, we present our experience with the use of the pedicled vascularized fibula graft through a posterior approach for reconstruction of tibial non-union in a patient who achieved successful bony union in nine months. The advantages of a pedicled vascularized fibula graft are that time-consuming microvascular anastomosis is not required and distant donor-site morbidity, which can occur with free fibular grafts, can be avoided. The disadvantage of utilizing a pedicled vascularized fibula graft is the possible loss of mechanical support, which can cause the leg to be more unstable than if a free vascularized fibula graft is used from the contralateral side. Thus, the pedicled vascularized fibula graft was confirmed to be a useful option for the reconstruction of tibial non-union, and a posterior approach is especially useful in trauma cases. The advantages of using the posterior approach include entering through healthy skin, good tissue planes for dissection, and full visualization of the fibula and peroneal vessels. However, it should be noted that a pedicled vascularized fibula graft is more difficult to harvest in an injured leg or at the site of infection where scar tissue surrounds the vascular pedicle.