Use of a vascularized fibula for spinal reconstruction in neurofibromatosis

作者：Bourdais L^*; Hamel A; Hamel O; Pannier M; Duteille F

来源：Annales de Chirurgie Plastique Esthetique, 2008, 53(3): 293-297.

DOI：10.1016/j.anplas.2007.05.005

• free vascularized fibula
• thoracic spinal reconstruction
• neurofibromatosis
• reconstructive microsurgery

We report a case of reconstruction of a dysplasic thoracic spine with vascularized fibula in Recklinghausen's disease. We present the case of a thirteen-year-old lady with neurofibromatosis type 1 who developed a dystrophic thoracic kyphoscoliosis. AT9 compression due to a severe scaloping of the thoracic spine caused an important deformation and a medullar compression (with dorsal pain, right sciatica and a pyramidal syndrome). The surgery consisted in medullar Liberation by a T9-T10 corporectomy and an osteosynthesis with arthrodesis T3-L3. A free vascularized fibula bone graft, with an end-to-end anastomosis on a thoracic pedicle, was realized to fill the T8-T11 spinal defect. All the symptoms decreased after surgery and the patient could walk normally few months later. At one-year follow-up the radiographs showed a stable montage and a solid bony fusion. Analysing the literature, vascularized bone graft can be recommended to fit[ the bony spinal defect due to surgery in cases of tumor, infection, trauma or severe scoliosis. Compared to non-vascularized grafts, which are exposed to resorption, fatigue fracture and then instability, the vascularized fibula grafts provide a rapid fusion, a biomechanically stable and Long-standing support with tow risks of infection.

• 出版日期2008-6