MICROSURGICAL FIBULAR FLAP FOR TREATMENT OF AVASCULAR NECROSIS OF THE FEMORAL HEAD

Abstract

Avascular necrosis of the femoral head is a potentially disabling disease that usually leads to destruction of the femoral head in patients. Its etiology and pathogenesis are unknown, despite recognition of various associated factors, such as trauma, coagulation abnormality, corticosteroid administration, excessive alcohol intake, and dysbaric phenomena. Results of these procedures have been inconsistent. Total hip arthroplasty is the treatment with the highest likelihood of providing symptom relief and good functional outcomes, but indications for this method are limited by device failures and prospects of repeated replacement of hardware in patients who undergo arthroplasty at a young age. The use of microsugical bone flaps in treating avascular necrosis of the femoral head was initiated in an effort to enhance revascularization and to arrest the progression of the necrosis. In this article, the author will discuss history, indications, techniques, and their results of using microsurgical fibular flaps in the treatment of avascular necrosis of the femoral head.

AVASCULAR NECROSIS OF THE FEMORAL HEAD IS A POTENTIALLY DISABLING DISEASE THAT USUALLY LEADS TO DESTRUCHON OF THE FEMORAL HEAD IN PAHENTS. ITS EHOLOGY AND PATHOGENESIS ARE UNKNOWN, DESPITE RECOGNIHON OF VARIOUS ASSOCIATED FACTORS, SUCH AS TRAUMA, COAGULAHON ABNORMALITY, CORHCOSTEROID ADMINISTRATION, EXCESSIVE ALCOHOL INTAKE, AND DYSBARIC PHENOMENA

MANY TECHNIQUES HAVE BEEN INTRODUCED TO SALVAGE THE FEMORAL HEAD, INCLUDING CORE DECOMPRESSION, OSTEOTOMY, AND BONE GRAFTING. RESULTS OF THESE PROCEDURES HAVE BEEN INCONSISTENT. TOTAL HIP ARTHROPLASTY IS THE TREATMENT WITH THE HIGHEST LIKELIHOOD OF PROVIDING SYMPTOM RELIEF AND GOOD FUNCTIONAL OUTCOMES, BUT INDICATIONS FOR THIS METHOD ARE LIMITED BY DEVICE FAILURES AND PROSPECTS OF REPEATED REPLACEMENT OF HARDWARE IN PAHENTS WHO UNDERGO ARTHROPLASTY AT A YOUNG AGE.

THE USE OF MICROSUGICAL BONE FLAPS IN TREATING AVASCULAR NECROSIS OF THE FEMORAL HEAD WAS INITIATED IN AN EFFORT TO ENHANCE REVASCULARIZATION AND TO ARREST THE PROGRESSION OF THE NECROSIS. SINCE MEYERS FIRST REPORTED ON THE MICROSURGICAL FIBULAR FLAP AS A TREATMENT FOR OSTEONECROSIS OF THE FEMORAL HEAD IN 1978, MANY SURGEONS HAVE PERFORMED THIS PROCEDURE FOR AVASCULAR NECROSIS OF THE FEMORAL HEAD, AND SATISFACTORY RESULTS HAVE BEEN REPORTED.

IN THIS WORK, WE WILL DISCUSS HISTORY, INDICATIONS, TECHNIQUES, AND OUR RESULTS OF USING MICROSURGICAL FIBULAR FLAPS IN THE TREATMENT OF AVASCULAR NECROSIS OF THE FEMORAL HEAD.

KEYWORDS: FIBULAR FLAP, AVASCULAR NECROSIS, REVASCULARIZATION