Longitudinal, Split, Half-Barreled, Free Vascularized Fibular Transplantation

Free vascularized fibular transplantation is one of the most useful living bone reconstructive procedures in the microsurgical field. Concerning donor site morbidity, the donor has minor problems of ankle stability, muscle power weakness, and transient peroneal nerve symptoms. These problems can be minimized with a longitudinal splitting osteotomy on the donor fibula, if the bone defect at the recipient site is not too large. With a half–split fibula with a peroneal arterial pedicle, which contains the nutrient artery and periosteal vessels, grafted bone can survive with these vascular supplies.

The author has experience with nine cases using half–split free vascularized fibular transplantation from 1985 to 2003. There was no evidence of devascularization in any case. Donor–site morbidity can be minimized by leaving the half fibula intact at the donor site. This technique is technically demanding in longitudinal splitting of the bone without damage to the peroneal nutrient vessels and periosteal soft tissue attached to the bone. The author nevertheless proposed longitudinal half fibular transplantation as one of the modifications in free vascularized bone transplantation that minimizes donor defect.