Reversed flow lateral circumflex femoral vessels as recipients for free fibular grafting in treatment of femoral head osteonecrosis

Free fibular bone grafting is an effective treatment for early osteonecrosis of the femoral head in young patients. However, recipient vessels are often small rendering microvascular anastomosis difficult. We have developed a novel technique using retrograde flow through the branches of the lateral...

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Bibliographic Details
Published in:Microsurgery 2010-01, Vol.30 (1), p.19-23
Main Authors: Lowrie, A. G., Rao, K., Nanu, A., Erdmann, M. W. H.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Anastomosis, Surgical
Bone Transplantation - methods
Cohort Studies
Female
Femoral Artery - surgery
Femoral Vein - surgery
Femur Head Necrosis - etiology
Femur Head Necrosis - pathology
Femur Head Necrosis - surgery
Fibula - blood supply
Fibula - transplantation
Humans
Male
Microsurgery
Regional Blood Flow
Retrospective Studies
Treatment Outcome
Young Adult
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Summary:Free fibular bone grafting is an effective treatment for early osteonecrosis of the femoral head in young patients. However, recipient vessels are often small rendering microvascular anastomosis difficult. We have developed a novel technique using retrograde flow through the branches of the lateral circumflex femoral artery to use the proximal end of the artery as the recipient vessel. A vessel diameter of up to 5 mm is obtained providing a good match with the peroneal vessels. We used this technique to perform vascularized bone grafting of the femoral head in 10 patients with Ficat grade 2 and 3 osteonecrosis. Pulsatile retrograde flow from the lateral circumflex femoral artery was observed in each case. Retrospective review gave a median follow up of 52 months (range 17–99). Symptoms improved in all 10 cases. There was no radiological deterioration over the period of follow‐up in eight cases. One patient underwent conversion to a total hip replacement 24 months after surgery. These results compare favorably with other studies. The lateral circumflex femoral artery turnover technique is a reliable and useful technique in vascularized bone grafting of the femoral head. © 2009 Wiley‐Liss, Inc. Microsurgery, 2010.
ISSN:0738-1085
1098-2752
DOI:10.1002/micr.20695