Free vascularised fibular graft to be used in the treatment of avascular necrosis of the femoral head; A more practical, new modification for graft preparation

Objectives: During the dissection of some blind areas for vascularized fibular graft, some failures may be seen due to prolonged surgical procedure. Our aim was to discuss a new modification developed to resolve the dissection problems encountered during the preparation of the graft on our subjects with avascular necrosis of the femoral head. Methods: Between 2011, 2012, a vascularized fibular grafting was applied on 6 cases (4 male, 2 female) using the modified technique. In the lateralization stage of the harvesting of the fibula, extra distal (15 mm) and proximal (25mm) fibular resections were included to facilitate the procedure and overcome getting a longer pedicle. Harvesting of the extra fibular grafts was performed at the fixation of the vascularized fibular graft at the femoral tunnel. Mean age was 37.8 (32- 40) and mean monitoring time was 16 (12-24) months. Results: All fibular grafts at the femoral head have been consolidated, and 5 cases were very good and 1 was good according to Merle d’Augbigne analyzing method at the control time. There were no complications during and after the preparation of the graft. Conclusion: We think that this modified technique is a useful method for getting grafts, and it ensures a shorter time for the preparation of the vascularized fibular graft.