Vascular microsurgery in orthopaedics.

Three applications of free vascularised bone grafts are described. Free fibular grafts have been performed in 19 cases of avascular necrosis of the femoral head. The grafts are placed along the anterior femoral neck and into the femoral head with a microvascular anastomosis between the nutrient vessels of the fibula and the anterior circumflex pedicle of the hip. The operative technique is described but the post-operative follow-up is still too short to draw any definite conclusions. This operation has been performed in young patients in whom the only alternative would be a total hip replacement. Free vascularised transfers of iliac crest bone are described for bone defects such as infected non-unions of the tibia with soft tissue and bony loss. Free vascularised fibula grafts have also been employed with cancellous grafting for cystic defects such as fibrous dysplasia and large bone cysts. The use of free vascularised fibula grafts is also described in four cases of congenital pseuodarthrosis of the tibia.