# Reconstruction of the Femoral Diaphysis Using the Vascularized Fibula Flap: A Case Report

## TL;DR

A patient with a severe femoral bone defect was successfully treated with a vascularized fibula flap, avoiding amputation and allowing long-term mobility.

## Contribution

Demonstration of successful limb salvage using a vascularized fibula flap for a complex femoral diaphysis defect.

## Key findings

- A 27-cm fibula flap was successfully transplanted to reconstruct a femoral defect.
- The patient remained ambulatory with minimal complications at a 10-year follow-up.
- Limb shortening was managed effectively with a custom shoe.

## Abstract

The vascularized fibula flap is often utilized in various reconstructive surgeries to cover a bone or soft tissue defect due to its generous length, adequate vascularization, and the possibility of removal with minimal loss of limb function. We present a 32-year-old male patient with a 27-cm femoral diaphysis defect caused by a high-impact car accident, which led to multiple femoral fractures and was further complicated by osteomyelitis. Initial consultations with other physicians advised limb amputation as the sole approach due to the severity of the case and potential complications. Upon presentation at Kuzanov Clinic, the possibility of salvaging the limb using the vascularized fibula flap was proposed. A 27-cm fibula flap was harvested and transplanted to the femoral defect. Anastomosis was established between the vasculature of the flap and the recipient zone. A few months after the surgery, an upper fibular fracture occurred, which later healed, and the fibula hypertrophied. At a 10-year follow-up, the patient remains ambulatory, with limb shortening effectively managed with a custom shoe.