J Reconstr Microsurg 2008; 24(8): 583-587
DOI: 10.1055/s-0028-1090603
© Thieme Medical Publishers

Double-Barrel Free Fibula Flap for Treatment of Infected Nonunion of Both Forearm Bones

Michel Saint-Cyr1 , Jordan Farkas1 , Amit Gupta2 , 3
  • 1Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
  • 2Department of Surgery, Division of Hand Surgery, University of Louisville School of Medicine, Louisville, Kentucky
  • 3Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, Kentucky
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16. Oktober 2008 (online)


Free vascularized bone transfer is a viable treatment option for extensive bony defects greater than 6 to 8 cm involving scarred, poorly vascularized, or infected recipient beds, such as in chronically infected nonunion of the radius and ulna treated with a double-barrel free fibula flap. Both patients reported here experienced bony union with significant resolution of their symptoms. Although range of motion improved following an aggressive physical therapy regimen, pronation was adversely affected. Chronic infected nonunions or nonunions from radionecrosis involving large segmental defects of both forearm bones are a truly unique challenge and must be treated aggressively to ensure any useful long term function of the injured limb.


Michel Saint-CyrM.D. F.R.C.S.(C) 

Department of Plastic Surgery, UT Southwestern Medical Center

1801 Inwood Road, Dallas, TX 75390-9132

eMail: michel.saint-cyr@utsouthwestern.edu