Versatility of Free Vascularised Fibular Flap in Extremity Reconstruction: A Retrospective Study

Main Article Content

Deviprasad Sulli Shruti G Raikar Chandni Shankar Mohammed Inayathulla Khan Suresh K K Imthiaz Ahammed


Introduction: Complex wounds of the extremities have always been a challenge for the reconstructive surgeon. Non-vascularized methods for the reconstruction of bony defects are associated with more complications. So the free vascularised fibular flap (FVFF) has become a workhorse flap for the reconstruction of these defects. In this study we aim to share our experience of reconstruction of such defects using free vascularised fibular flap.

Material and methods: We performed a retrospective study of the 18 patients who underwent extremity reconstruction with free vascularised fibular flap  at our hospital i.e. Yenepoya Medical College and Hospital, Mangaluru during a five-year period i.e. from January 2019 to December 2023. In all these patients, we studied and evaluated the cause and location of defects, type of free vascularised fibular flap, choice of the recipient vessels, type of the anastomosis, the survival rate, functional outcomes and complications.

Results: Totally 18 patients with a mean age of 39.4 years had undergone extremity reconstruction with a free vascularised fibular flap with complete bone viability. The defects were present within the humerus, radius, femur, tibia and metatarsal. Union at the osteotomy sites was noted radiologically at an average time of five months. The average period to return function was 14 months.

Conclusions: The use of a free vascularised fibula flap is the best modality for the reconstruction of the bony defects of the limb and is proved to have a high bony healing rate, early return to ambulation, good function of the extremity and less incidence of complication regardless of the cause of the bony defect. One or more skin paddle can be taken along with the bone for the coverage in case of exposure of deeper tissue.

Keywords: Free vascularised fibular flap, Extremity defect, Microsurgery, Upper limb, Lower limb

Article Details

How to Cite
SULLI, Deviprasad et al. Versatility of Free Vascularised Fibular Flap in Extremity Reconstruction: A Retrospective Study. Medical Research Archives, [S.l.], v. 12, n. 6, june 2024. ISSN 2375-1924. Available at: <>. Date accessed: 22 july 2024. doi:
Research Articles


1. Ozalp, T., Masquelet, A.C. & Begue, T.C. Septocutaneous perforators of the peroneal artery relative to the fibula: anatomical basis of the use of pedicled fasciocutaneous flap. Surg Radiol Anat. 2006;28:54–58. DOI: 10.1007/s00276-005-0059-7
2. Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft: a clinical extension of microvascular techniques. Plast Reconstr Surg. 1975;55:533-44. DOI: 10.1097/00006534-197505000-00002
3. Beris AE, Lykissas MG, Korompilias AV, et al. Vascularized fibula transfer for lower limb reconstruction. Microsurgery. 2011;31(3):205–211. DOI: 10.1002/micr.20841
4. KorompilIas AV, Paschos NK, Lykissas MG, Kostas-Agnantis I, Vekris MD, Beris AE. Recent updates of surgical techniques and applications of free vascularized fibular graft in extremity and trunk reconstruction. Microsurgery. 2011;31(3):171–175. DOI: 10.1002/micr.20848
5. Soucacos PN, Korompilias AV, Vekris MD, Zoubos A, Beris AE. The free vascularized fibular graft for bridging large skeletal defects of the upper extremity. Microsurgery. 2011;31(3):190–197. DOI: 10.1002/micr.20862
6. Malizos KN, Beris AE, Xenakis TA, Korobilias AB, Soucacos PN. Free vascularized fibular graft: a versatile graft for reconstruction of large skeletal defects and revascularization of necrotic bone. Journal of Microsurgery. 1992;13:182–187. DOI: 10.1002/micr.1920130407
7. Pho RWH, Satku K, Kumar VP, Kim HM. The vascularised bone graft in reconstruction following bone tumour resection. Semin Orthop. 1986;1:156–64.
8. Choong PF, Sim FH. Limb-sparing surgery for bone tumors: new developments. Semin Surg Oncol. 1997;13(1):64-9. DOI: 10.1002/(sici)1098-2388(199701/02)13:1<64::aid-ssu10>;2-9
9. Ozaki T, Hillmann A, Wuisman P, Winkelmann W. Reconstruction of tibia by ipsilateral vascularized fibula and allograft. 12 cases with malignant bone tumors. Acta Orthop Scand. 1997;68(3):298–301. DOI: 10.3109/17453679708996706
10. Garcia RG, Gias LN, Campo FJR, Guerra MFM, Perez JS. Vascularized free fibular flap for the reconstruction of mandibular defects: clinical experience in 42 cases. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2008;106(2):191-202. DOI: 10.1016/j.tripleo.2007.04.002
11. Taylor GI. Reconstruction of the mandible with free composite iliac bone grafts. Ann Plast Surg. 1982;9:361-76. DOI: 10.1097/00000637-198211000-00003
12. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993 Jan;(286):241- 246. PMID: 8425352. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system.
13. Basheer MH, Wilson SM, Lewis H, Herbert K. Microvascular free tissue transfer in reconstruction of the lower limb. J Plast Reconstr Aesthet Surg. 2008;61:525-8. DOI: 10.1016/j.bjps.2007.03.029
14. P.J. Belt, I.C. Dickinson, D.R.B. Theile. Vascularised free fibular flap in bone resection and reconstruction. British Journal of Plastic Surgery. 2005;58:425–430. DOI: 10.1016/j.bjps.2004.11.002
15. Hsu RWW, Wood MB, Sim FH, Chao EYS. Free vascularised fibular grafting for reconstruction after tumour resection. J Bone Joint Surg Br. 1997;79(1):36–42. DOI: 10.1302/0301-620x.79b1.6818 PMID: 9020442.
16. Ihara K, K Doi, M Yamamoto, S Kawai: Free vascularized fibular grafts for large bone defects in the extremities after tumour excision. J Reconstr Microsurg. 1998;14(6):371–6. DOI: 10.1055/s-2007-1000193
17. Shea KG, Coleman, Scott, et al. Microvascular free fibular grafts for reconstruction of skeletal defects after tumour resection. J Pediatr Orthop. 1997;17(4):424–32. 17(4):p 424-432, July 1997.
18. Brunelli G, Vigasio A, Battiston B, Di Rosa F, Brunelli G Jr. Free microvascular fibular versus conventional bone grafts. Int Surg. 1991;76:33–42. PMID: 2045250. Free microvascular fibular versus conventional bone grafts.
19. Chen CM, Disa JJ, Lee HY, et al. Reconstruction of extremity long bone defects after sarcoma resection with vascularized fibula flaps: a 10-year review. Plast Reconstr Surg. 2007;119:915–924; discussion 925. DOI: 10.1097/01.prs.0000252306.72483.9b
20. Vander Griend RA. The effect of internal fixation on the healing of large allografts. J Bone Joint Surg Am. 1994;76:657–663. DOI: 10.2106/00004623-199405000-00005 PMID: 8175812.
21. Innocenti M, Delcroix L, Manfrini M, Ceruso M, Capanna R. Vascularized proximal fibular epiphyseal transfer for distal radial reconstruction. J Bone Joint Surg Am. 2004;86(7):1504–1511. DOI: 10.2106/00004623-200407000-00021 PMID: 15252100.
22. Akinbo O, Strauch R. Physeal transfers for skeletal reconstruction. J Hand Surg Am. 2008;33(4):584–590. DOI: 10.1016/j.jhsa.2007.12.023 PMID: 18406964.
23. Medrykowski F, Barbary S, Gibert N, Lascombes P, Dautel G. Vascularized proximal fibular epiphyseal transfer: two cases. Orthop Traumatol Surg Res. 2012;98(6):728–732. DOI: 10.1016/j.otsr.2012.05.009
24. Yoshimura, M, Shimamura K, Iwai Y, Yamauchi S, Ueno T. Free vascularized fibular transplant. A new method for monitoring circulation of the grafted fibula. The Journal of Bone & Joint Surgery. 1983;65(9):1295-1301. DOI:10.2106/00004623-198365090-00011
25. Amr SN, El-Mofty AO, Amin SN, Morsy AM, El-Malt OM, AbdelAal HA. Reconstruction after resection of tumours around the knee: role of the free vascularized fibular graft. Microsurgery. 2000;20(5):233–51. DOI:10.1002/1098-2752(2000)20:5<233::aid-micr4>;2-o
26. Fragnière B, Wicart P, Mascard E, Dubousset J. Prevention of ankle valgus after vascularized fibular grafts in children. Clin Orthop. 2003;408:245-51. DOI:10.1097/00003086-200303000-00032 PMID: 12616066.
27. Minami A, Kasahima T, Iwasaki N, Kato H, Kaneda K. Vascularised fibular grafts: an experience of 102 patients. J Bone Joint Surg Br. 2000;82(7):1022-5. DOI: 10.1302/0301-620x.82b7.10332 PMID: 11041594.
28. Han CS, Wood MB, Bishop AT, Cooney WP 3rd. Vascularized bone transfer. J Bone Joint Surg Am. 1992;74(10):1441-9. Vascularized bone transfer PMID: 1469003.