Vascularized Fibular Graft — Indications and Techniques
DNB Orthopaedics • October 2024 • Paper III • 10 Marks
Introduction
A vascularized fibular graft (VFG) is a segment of fibula transferred together with its nutrient vascular pedicle so that the graft remains biologically viable after transplantation. It may be transferred as a free vascularized fibular graft (FVFG) using microvascular anastomosis or, in selected ipsilateral lower-limb defects, as a pedicled vascularized fibular graft.
Unlike a conventional non-vascularized cortical graft, a VFG contains living osteocytes and an intact blood supply, allowing rapid incorporation, biological hypertrophy and healing even in poorly vascularized recipient beds.
Core principle
Vascularized fibula combines structural cortical support + osteogenic potential + immediate intrinsic blood supply.
Why the Fibula Is an Ideal Vascularized Graft
- Long straight segment of strong cortical bone can be harvested.
- Provides excellent structural support for segmental bone defects.
- Reliable vascular pedicle based predominantly on the peroneal artery and venae comitantes.
- Can be harvested with periosteum, muscle and skin paddle if required.
- Can undergo progressive hypertrophy after transfer and mechanical loading.
- May be used as an osteocutaneous flap for combined bone and soft-tissue defects.
Relevant Vascular Anatomy
The principal nutrient supply to the…