Vascularised Fibula Transfer for Post-traumatic Critical Tibial Bone Defects: A Systematic Review.

IF 1.3 Q3 ORTHOPEDICS
Sevasti P Glynou, Ariadni Georgiannakis, Daria Ardolino, Simon Craxford, Alexandros Vris
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引用次数: 0

Abstract

Introduction: Managing post-traumatic critical bone defects in the tibia remains challenging. Vascularised free fibula grafts (VFFG) are an attractive option due to their versatility and ability to integrate with host bone. However, they are challenging, and their role compared to alternative techniques, such as bone transport and Masquelet, remains unclear. This study aims to assess the safety and effectiveness of free fibula flaps in reconstructing critical tibia defects following trauma.

Materials and methods: Five databases were searched for English-language studies from inception until August 2024. Inclusion criteria involved adult patients undergoing VFFG to the tibia for trauma-induced bone defects. Case reports and studies involving non-traumatic and/or critical bone injury and/or those not undergoing fibula transfer were excluded. Bias was assessed using the ROBINS-I tool.

Results: Fifteen studies involving 83 patients with a mean age of 35.07 ± 12.16 (range: 18-65) were included. Ipsilateral fibula transfer was preferred (n = 13, 80%), of and 89.7% fibulas (n = 35) were transferred using a single-barrel approach. The average union rate was 93.08% (95% CI: 86.56, 99.61) across the 74 patients where union outcomes were reported. Flap survival was 100% in seven studies, whilst two studies reported lower survival rates, the lowest being 50%. The overall complication rate was 39.98% (95% CI: 28.25, 51.71), with stress fractures occurring in 35.5% (n = 16) of cases. Revision rates varied from 10 to 40%. The risk of bias was high in 12 studies, and only three studies had a moderate risk. Four studies compared VFFG to alternative management strategies.

Conclusion: Vascularised free fibula grafts are effective for reconstructing large segmental tibia defects post-trauma, achieving high union and flap survival rates. However, complication rates are high, and study heterogeneity limits definitive conclusions on the technique's superiority. Further prospective comparative studies are required to characterise the role of VFFG.

How to cite this article: How to cite this article: Glynou SP, Georgiannakis A, Ardolino D, et al. Vascularised Fibula Transfer for Post-traumatic Critical Tibial Bone Defects: A Systematic Review. Strategies Trauma Limb Reconstr 2025;20(1):37-46.

Abstract Image

Abstract Image

带血管腓骨移植治疗创伤后严重胫骨骨缺损:系统综述。
引言:处理创伤后胫骨的严重骨缺损仍然具有挑战性。带血管的游离腓骨移植物(VFFG)由于其多功能性和与宿主骨融合的能力而成为一种有吸引力的选择。然而,它们具有挑战性,并且与骨运输和Masquelet等替代技术相比,它们的作用尚不清楚。本研究旨在评估游离腓骨皮瓣重建创伤后严重胫骨缺损的安全性和有效性。材料和方法:从成立到2024年8月,检索了5个数据库的英语研究。纳入标准包括因外伤性骨缺损而接受胫骨VFFG的成年患者。涉及非创伤性和/或严重骨损伤和/或未进行腓骨转移的病例报告和研究被排除在外。使用ROBINS-I工具评估偏倚。结果:纳入15项研究,涉及83例患者,平均年龄35.07±12.16(范围:18-65)。首选同侧腓骨转移(n = 13,80 %), 89.7%的腓骨(n = 35)采用单管入路转移。在74例报告了愈合结果的患者中,平均愈合率为93.08% (95% CI: 86.56, 99.61)。7项研究皮瓣存活率为100%,而2项研究报告存活率较低,最低为50%。总并发症发生率为39.98% (95% CI: 28.25, 51.71),其中应力性骨折发生率为35.5% (n = 16)。修订率从10%到40%不等。12项研究的偏倚风险较高,只有3项研究的偏倚风险中等。四项研究将VFFG与其他管理策略进行了比较。结论:带血管的游离腓骨移植是修复创伤后大节段胫骨缺损的有效方法,具有较高的愈合率和皮瓣成活率。然而,并发症发生率高,研究异质性限制了对该技术优越性的明确结论。需要进一步的前瞻性比较研究来描述VFFG的作用。如何引用本文:如何引用本文:Glynou SP, Georgiannakis A, Ardolino D, et al。带血管腓骨移植治疗创伤后严重胫骨骨缺损:系统综述。创伤肢体重建2025;20(1):37-46。
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来源期刊
Strategies in Trauma and Limb Reconstruction
Strategies in Trauma and Limb Reconstruction Medicine-Orthopedics and Sports Medicine
CiteScore
1.50
自引率
0.00%
发文量
31
期刊介绍: Strategies in Trauma and Limb Reconstruction is dedicated to surgeons, allied medical professionals and researchers in the field of orthopaedics and trauma. The scope of the journal is to discuss the fields of skeletal injury, and the complications thereof, congenital and acquired limb deformities and deficiencies, and orthopaedic-related infection, together with their surgical and non-surgical treatments. The journal publishes original articles, reviews, case reports, descriptions of new or recognised treatment techniques, forum discussions of clinical scenarios and relevant correspondence. It aims to provide a widely accessible source of useful information to practitioners in the field through the problem- or technique-based approach of published articles.
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