Free vascularized fibular grafts were used to treat seventeen patients
who had extensive defects and pseudarthroses in long bones of the
extremities. Of the seventeen, thirteen had been followed for from eighteen
months to five years and could be evaluated. All thirteen grafts healed
with no radiographic evidence of bone necrosis or resorption. During the
immediate postoperative period, the patency of the anastomoses was
monitored by observing the color of the skin of an island pedicle
(so-called buoy) skin graft whose blood supply was in continuity with that
of the fibular graft. Preoperative Doppler measurements were used to
determine the most favorable location for the island pedicle graft. In the
presence of defects of both bone and skin, the skin defect can be covered
by using a large buoy flap. The largest flap used in this series measured
fifteen square centimeters.