The use of free vascularized fibular graft (FVFG) is nowadays a common procedure for severe segmental bone loss. Thrombosis of the microanastomosis leads to a lack of bone incorporation of the FVFG unless a successful early exploration would have been performed. Due to this fact, the continuous monitoring of the FVFG viability in the immediate postoperative period needs to be executed. The use of a variety of methods has been proposed to asses the viability on an intermittent basis. These include selective angiography, monitoring of healing and hypertrophy with serial radiographs, bone scan and Doppler ultrasound scanning. Intermittent monitoring methods, however, will not detect acute thrombosis. Continuous monitoring is possible with instrumental methods such as the laser Doppler implants, the thermocouple probes, and the measurement of electrochemically or clinically produced hydrogen or using the fibular cutaneous flap that works as a buoy. Since the last method was proposed in 1993, we started to use it in our unit, but many controversies arised regarding its efficacy. For this reason we decided on the current study, to analyze the sensibility and the specificity of the fibular flap as a monitor of the microanastomosis in the FVFG.
Fibular flap; Free bone transfer; Microsurgery
