Mayo surgeons use new procedure to salvage limbs

Monday, August 19, 2002

JACKSONVILLE, Fla., Aug. 8, 2002 — Surgeons at Mayo Clinic in Jacksonville, Fla., are using a surgical procedure to salvage limbs that might otherwise be amputated. Cancer, trauma or congenital defects can cause substantial bone defects, rendering a limb nonfunctional. Surgeons remove the section of diseased, damaged or dead bone; then fill the space with a section of living bone. The preferred donor site is one of the patient's fibulas — the smaller of the two lower leg bones. When the fibula is harvested with its blood vessel, it can fill defects and rejuvenate dead bone. The procedure, called free vascularized fibular grafting, is also used to reconstruct bone at the hip joint that has lost its blood supply, a condition called osteonecrosis.

The blood vessel taken along with the section of fibula is attached to an existing blood vessel in the leg with the defect. This resupplies blood to the reconstructed bone (revascularizes the bone), and the grafted bone provides structural support. "The bone is revascularized and no longer dead," says Dr. Peter Murray, a Mayo Clinic hand and microvascular surgeon who performs the procedure. "The advantage of this procedure over a conventional bone graft or a cadaveric bone graft is that this becomes living bone, so it has a higher chance of healing and a smaller chance of getting infected."

People can live without a fibula, and Murray says about 75 percent of the central part of it can be removed for the procedure without causing problems for the patient. That amounts to about 12 inches of adult bone that can be used to reconstruct cancerous bones or fractured bones that will not grow back together without a graft. Murray says he and his colleagues have used a portion of the fibula to reconstruct the femur, (upper leg bone) humerus (upper arm bone), tibia (lower leg bone) and even the jaw.

Free vascularized fibular grafting is major surgery that takes about six to eight hours to perform depending on the primary reason for the surgery. "Sometimes we're doing two or maybe three surgeries at the same time," Murray says. "We're doing surgery to remove the tumor or surgery to deal with the fracture as well as the bone harvest and graft."

Murray says the procedure is a viable option and an alternative to amputation regardless of the patient's age. Smokers and those with vascular disease are not good candidates. And the procedure is not as effective if the native bone — the bone to be reconstructed — is already dead.

Success is largely dependent on the condition of the recipient limb. "This is a big operation for very difficult problems," Murray says. "And often the native limb is not in very good condition."

After the surgery, doctors look at X-rays taken every six to eight weeks to see if the bone is healing. Patients will be on crutches or in a cast until it does. Murray says the appearance of the reconstructed limb varies depending on its pre-existing condition. The leg, from which the portion of the fibula was taken, looks essentially the same after the surgery.

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