Summary
Transfer of a vascularised free fibular bone for reconstruction of the cervical spine
has been described previously.
1
,
2
,
3
,
4
However, this is the first report of a reconstruction with both an osteocutaneous
fibular flap for anterior stabilisation and a double-islanded osteocutaneous fibular
flap for posterior stability.We present a case of an osteoclastoma in C2 initially treated with radiotherapy 1.8 Gy × 30.
Two months after radiotherapy, the patient developed severe osteoradionecrosis and
luxation of C2 causing neurological impairment. The patient was treated with cervical
traction for 10 days. Resection of C2 was performed through a posterior approach and
a secondary transoral approach. The spine was stabilised from a posterior approach
using allografts and a titanium plate and rod construct (Vertex™) from the occipital
squama to C5 and from an anterior approach with allograft filled cage from C1 to C3.
Two months later, rupture of the pharyngeal wall was noted with exposure of the anterior
cage. A few days later, the posterior scar ruptured. The anterior cage was removed
and the pharyngeal wall was sutured. Revision of the posterior wound was performed,
leaving the implants in place. To secure stability of the spine, the patient was treated
with a HALO. Once again, the pharyngeal wall ruptured. Reconstruction of the posterior
pharyngeal wall and the anterior column of the spine was performed with an osteocutaneous
fibular flap from the skull base to C3. Five months later, a computed tomography (CT)
scan showed insufficient bony fusion of both anterior and posterior bone grafts, and
the posterior wound had not healed. A second osteocutaneous fibular flap was placed
bilaterally from the occipital squama to the posterior elements of Th1, closing the
wound defect.
Apart from the occipital squama, fusion was seen at all sites after 14 months, and
the HALO was removed.
Keywords
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References
- Use of the vascularized free fibular graft with an arteriovenous loop for fusion of cervical and thoracic spinal defects in previously irradiacted pediatric patients.Plast Reconstr Surg. 2011; 12: 1932-1938
- Simultaneous reconstruction of the posterior pharyngeal wall and cervical spine with a free vascularized fibular osteocutaneous flap.Plast Reconstr Surg. 2002; 109: 1361-1365
- Ventral cervical fusion at multiple levels using free vascularized double-islanded fibular – a technical report and review of the relevant literature.Eur Spine J. 2002; 11: 176-182
- The use of free vascularized bone grafts in spinal reconstruction.JPRAS. 2010; 63: 516-523
- Giant cell tumor of the pelvic and sacrum. 17 cases and analysis of the literature.Clin Orthop Relat Res. 2004; 423: 196-207
- Giant cell tumor of the sacrum and spine: series of 23 cases and a review of the literature.Iowa Orthop J. 2010; 30: 69-75
- En bloc resection of 3 vertebra in pancoast patient: longterm stability using a free vascularized fibular graft.Ann Thorac Surg. 2011; 91: 295-298
- The use of vascularized fibular graft for the reconstruction of the spine and sacral defect.Microsurgery. 2009; 29: 393-400
- Comparision of residual osseous mass between vascularized and nonvascularized onlay bone transfers.Plast Reconstr Surg. 1983; 72: 672-674
- Revascularized segmental diaphyseal bone transfers in the canine – an analysis of viability.J Reconstr Microsurg. 1984; 1: 11-19
Article info
Publication history
Published online: March 07, 2012
Accepted:
February 4,
2012
Received:
February 1,
2012
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
