The 2004 Annual Meeting (January 14-20, 2004) of OASYS_NEW

Not yet assigned to a slot - 3:40 AM

Vascularized free fibular grafts in spinal reconstruction

Rishavy TJ1, Khan SU1, Shin A2, Bishop AT3, Dekutoski M4, Wilden J5, and Moran SL1. (1) Plastic and Reconstructive Surgery, Mayo Clinic, East 6, 200 First Street SW, Rochester, MN, USA, (2) Division of Hand and Microsurgery, Division of Plastic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA, (3) Orthopedic-Hand &Microsurgery, Mayo Clinic, East 14, 200 First Street SW, Rochester, MN, USA, (4) Orthopedic - Spine Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, USA, (5) Mayo Clinic, Rochester, MN, USA

Background: Vascularized free fibular grafts have been described previously for use with spinal reconstruction in instances of failed arthodesis, tumor, and osteoporosis. The majority of the literature is consists of case reports, with a few small series, documenting the benefits of this type of reconstruction. The advantages of vascularized bone grafts include: faster rates of fusion, resistance to resorptive fractures, and maintenance of structural integrity.

Methods: Over a nine year period at our instition, seven patients received a vascularized free fibular graft to augment their spinal reconstruction in the presence of infection, trauma, or tumor. We performed a retrospective chart review looking specifically at presentation, work-up, graft length, levels spanned, and time to fusion. In addition, post-operative morbidity and mortality, as well as complications were reviewed.

Results: Seven patients underwent spinal reconstructive.surgery during the time period of 1993-2002. Their ages ranged from 14-58 years (mean 45 years). The most common presenting symptom was lower back pain (6/7, 85%). The majority of our patients (6/7) 85% were referred from an outside institution for a secondary salvage procedure. There was evidence of wound infection in (5/7) 70% at initial presention. While the harvested fibular length ranged from 15-25cm (mean, 21cm), the grafts themselves spanned from one to six (mean two) vertebral levels in the thoracolumbosacral region. Initial evidence of fusion was seen on postoperative standard radiographs. Viability of the grafts was confirmed via computed tomography (CT) in four patients at 12 to 40 months (mean, 22.5 months) postoperatively. Aside from a few minor wound infections, there were no microvascular failures, although in one case the graft had to be exchanged for a contralateral free fibula secondary to the development of an arteriovenous malformation (AVM). At last follow-up [range from 4-85 months (mean, 50 months)], all patients were ambulatory and there were no deaths. In addition, there were no donor site complications.

Conclusion: In those settings were patients present with a difficult reconstructive option, we believe that vascularized free fibular grafts for spinal fusion may provide a means of improving structural stability and union rates. A thorough review of literature has verified this to be the largest series to date involving the use of these grafts in the presence of infection. Our results confirm the notion that vascularized free fibular grafts are a safe, secure, and successful choice in the armamentarium of reconstructive spine surgery.


Back to Scientific Paper Session F
Back to American Society for Reconstructive Microsurgery

Back to The 2004 Annual Meeting (January 14-20, 2004)