Vascularised Fibula Transfer for Post-traumatic Critical Tibial Bone Defects: A Systematic Review.

Introduction: Managing post-traumatic critical bone defects in the tibia remains challenging. Vascularised free fibula grafts (VFFG) are an attractive option due to their versatility and ability to integrate with host bone. However, they are challenging, and their role compared to alternative techniques, such as bone transport and Masquelet, remains unclear. This study aims to assess the safety and effectiveness of free fibula flaps in reconstructing critical tibia defects following trauma. Materials and methods: Five databases were searched for English-language studies from inception until August 2024. Inclusion criteria involved adult patients undergoing VFFG to the tibia for trauma-induced bone defects. Case reports and studies involving non-traumatic and/or critical bone injury and/or those not undergoing fibula transfer were excluded. Bias was assessed using the ROBINS-I tool. Results: Fifteen studies involving 83 patients with a mean age of 35.07 ± 12.16 (range: 18-65) were included. Ipsilateral fibula transfer was preferred ( Conclusion: Vascularised free fibula grafts are effective for reconstructing large segmental tibia defects post-trauma, achieving high union and flap survival rates. However, complication rates are high, and study heterogeneity limits definitive conclusions on the technique's superiority. Further prospective comparative studies are required to characterise the role of VFFG. How to cite this article: How to cite this article: Glynou SP, Georgiannakis A, Ardolino D,