Bone graft with microvascular anastomosis; fibula
CPT4 code
Name of the Procedure:
Bone graft with microvascular anastomosis; fibula. Commonly referred to as "Fibula Free Flap" or "Vascularized Fibular Graft."
Summary
A bone graft with microvascular anastomosis using the fibula involves transplanting a section of the fibula bone, along with its blood supply, to another part of the body where bone reconstruction is required. The blood vessels from the fibula are connected (anastomosed) to blood vessels at the recipient site to ensure the graft remains viable.
Purpose
This procedure addresses significant bone defects or loss due to trauma, congenital deformities, or cancer. The goal is to restore structural integrity and function to the affected bone area, ensuring stable and durable reconstruction.
Indications
- Large bone defects from trauma or surgery
- Conditions like non-union fractures or osteomyelitis
- Tumors requiring bone reconstruction
- Congenital bone deficiencies Patients with good overall health who require reconstruction of significant bone loss are appropriate candidates for this procedure.
Preparation
- Fasting: Patients may need to fast for 8-12 hours before surgery.
- Medication Adjustments: Instructions on withholding certain medications, such as blood thinners, will be provided.
- Diagnostic Tests: Pre-surgical imaging (X-rays, CT scans) and blood tests will be conducted to assess the patient’s suitability for surgery.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Harvesting the Fibula: An incision is made along the leg to expose and remove a segment of the fibula with its blood vessels.
- Preparation of Recipient Site: The site needing reconstruction is prepared by cleaning and shaping it to receive the graft.
- Microvascular Anastomosis: Surgeons connect the blood vessels from the fibula segment to vessels at the recipient site using a microscope and micro-surgical techniques.
- Bone Fixation: The transferred fibula segment is secured to the existing bone using screws, plates, or other fixation devices.
- Closure: Incisions are closed with sutures, and surgical sites are dressed.
Duration
The procedure typically takes 6-10 hours, depending on the complexity and specific case requirements.
Setting
This complex surgery is performed in a hospital operating room, equipped with advanced microvascular instrumentation.
Personnel
- Orthopedic or Plastic Surgeons specializing in microvascular techniques
- Anesthesiologists
- Surgical Nurses
- Operating Room Technicians
Risks and Complications
- Infection at the surgery site
- Blood clots or poor healing at the graft site
- Failure of the graft due to inadequate blood flow
- Nerve injury or loss of limb function
- Long-term complications such as chronic pain or stiffness
Benefits
- Restoration of normal bone structure and function
- Improved appearance if the bone defect was visible
- Enhanced ability to bear weight and perform daily activities
- Benefits may be noticeable immediately after recovery, although full functionality might take several months.
Recovery
- Hospital Stay: Typically 5-7 days post-surgery
- Post-procedure Care: Pain management, antibiotics, and wound care instructions will be provided.
- Recovery Time: May vary from 6 months to a year, with physical therapy recommended for optimal recovery.
- Restrictions: Avoid putting weight on the grafted area initially, with gradual reintroduction as healing progresses.
- Follow-Up: Regular appointments to monitor graft healing and functionality.
Alternatives
- Non-vascularized bone grafts: May be less complex but have higher failure rates for large defects.
- Synthetic bone substitutes: Useful in specific cases but may not integrate as well as natural bone.
- Amputation: In severe cases, might be considered but comes with its own set of challenges and limitations.
Patient Experience
- During the Procedure: Patients remain under general anesthesia and will not feel any pain.
- Post-Procedure: Pain, swelling, and discomfort are common but managed with medication.
- Long-term: Patients may experience improved function and quality of life once fully healed. Physical therapy is crucial for optimal recovery.
Pain management includes prescribed pain relievers, and comfort measures such as cold packs and elevation of the affected limb can help reduce swelling and discomfort.