Free microvascular fibular versus conventional bone grafts.

Free microvascular grafts have many advantages over conventional bone grafts. Above all they do not undergo creeping substitution and live on their own vessels, thus being able to heal quickly and fight infection. Research in rabbits has been done with radiographic, scintigraphic and light and fluorescence histologic examination which demonstrated the high superiority of quality, reliability and rapidity in healing of the microvascular bone transfer as related to avascular ones. Eighty-five cases of free microvascular fibular transfers starting in 1975 are presented including six congenital cases, 12 non-unions, eight osteitis, seven tumors, seven large losses of bone and 45 femoral head necrosis. The failure ratio is very low. Six primary failures were cured by plaster or additional cancellous bone grafts. Four failures (in femoral head necrosis) did not cure due to recession of the graft, its reabsorption or progression of avascular necrosis in two corticosteroid cases.