Twin-barrelled vascularized fibular grafting to the pelvis and lower extremity.

From 1988 to 1992, 17 patients were treated for a large bone defect or established nonunion of the pelvis or lower extremities with twin-barrelled vascularized fibular grafts. There were 13 men and four women whose average age at operation was 39 years (range, 13-73 years). The reconstructed site was the pelvis in two patients, the femur in 12, the tibia in two, and the ankle in one. The mean length of the bone defect was 8.5 cm, and the mean length of the harvested fibula was 22 cm. Free grafts were transferred in 14 patients and pedicle grafts in three patients. The mean duration of the operation was six hours 46 minutes (range, 3.5-10.6 hours). Average blood loss was 1949 ml (range, 268-5308 ml). In one patient, the vascularized transfer failed, and recurrence of local infection was encountered in another. In the remaining 15 patients, the postoperative course was uneventful; the mean period to bony union was 5.1 months (range, two to 12 months). The mean time to full weight bearing was four months in pelvic reconstruction, 10.6 months in femoral reconstruction, and 6.3 months in leg reconstruction. Only one patient had a fracture of the fibular graft. This method is well suited for patients with a bone defect up to 13 cm in length of the pelvis or lower extremities.