(FVFG) FREE VASCULARISED FIBULAR GRAFT – ADVANTAGES & TECHNIQUE IN CONGENITAL PSEUDARTHROSIS OF TIBIA – 2 CASES / BOYD TYPE III

BOYD TYPE 3: Fracture thru anteriorly bowed tibia with narrowing and sclerosis. Dictum – Osseous union is more difficult to obtain in this condition than in any other. Morissey (1982) – in extensive review of literature found that of 91 patients only 55% progressed to bony union after 23 different types of surgeries. The principal limitation is: inadequate excision of pathological tissue & bone due to inadequate means of bridging the gap so created. FVFG allows radical excision of all abnormal / diseased tissue till you have obviously healthy bone above and below & replacement with vascularised normal bone. 1. Critical Points in Harvesting the Fibula :- During superior fibular osteotomy dissection must be subperiosteal to avoid damage to anterior tibial vessels and nerve. 2. Anteriorly, extensors & interosseous membrane dissected away from deep peroneal nerve which is kept with the medial muscle mass. 3. Posteriorly enter plane between soleus and gastrocnemius. Soleus is cut away from fibula leaving a 0.5. cm fringe of muscle in order to preserve musculoperiosteal vessels. 4. Porotic distal fibular end is very short, wide & inadequate for fixation / stabilization. 5. Support maintained for 1 year to avoid stress fracture. 6. 1 patient united in 6 months & the other had distal nonunion, and needed bone grafting for union at 20 weeks & finally went on to unite in another 24 weeks.