Treatment of tibial defect with vascularized osteocutaneous pedicled transfer of fibula.

Free osteocutaneous fibular flap transfer has been used for long bone and soft tissue defects in both the lower and upper extremity. Since July, 1984, two cases of tibial defect, with severe scar formation on the anteromedial aspect, have been treated. An ipsilateral, vascularized, osteocutaneous, pedicled flap of the fibula was used to bridge the bony defect and to resurface the wound, after scar excision and bony debridement. The peroneal vessels were severed, leaving one side intact. The entire fibular flap was shifted anteromedially through a tunnel between the anterior and posterior tibialis. In addition to screw fixation of both ends of the transfer, an external fixator was used for three months. This technique has the advantages of obviating the need for vessel anastomoses and of completing the whole procedure on a single leg.