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Introduction: Free vascularized fibular bone grafts have become the most commonly used free vascularized bone grafts used to treat large post-traumatic defects caused by high-energy trauma, as well as large post-traumatic nonunions. Material and methods: We present two high energy trauma cases: a traumatic amputation of the forearm – 22C3 open Gustilo-Anderson type IIIC (case 1) with a 10 cm residual radial shaft defect and a paragliding accident resulting in a 43C3 open Gustilo-Anderson type IIIB (case 2) with a residual tibial shaft defect of 8 cm. The residual defect was treated in both cases with an osteoseptocutaneous free vascularized fibular bone graft. The follow-up was performed at 3 weeks, 3 months, 6 months, 1 year and 3 years. The bone graft showed radiological signs of integration at 3 months in both cases. The three-year follow-up revealed good clinical and excellent radiological results in case 1 and excellent clinical and radiological results in case 2. Conclusions: Free vascularized fibula grafting provides an attractive reconstructive option for orthopedic surgery. Free fibular grafting has been proven to be an ideal choice in the management of large segmental bone defects as well as in situations of biological failure of bone healing.

Free Vascularized Fibular Bone Graft, a Reliable Method for the Management of Large Skeletal Defects in Orthopaedic Trauma