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Free Vascularized Fibular Grafting

- Surgical Technique:

- Post Operative Care and Rehab:

- FVFG at Duke University:
    The staff of the Duke University Orthopaedics wishes to provide efficient & effective care for you.  The following information will enable you
          to utilize our practice most effectively.
    - Clinic Visits and Operative Scheduling:

- The most frequently asked questions:

1. What are the advantages or disadvantages in having a free vascularized fibular graft?  
       The advantage of a vascularized fibular grafting are the bone is transferred alive which means an early take; in addition, the blood 
       vessels spread out and form new bone.

2. How long can I wait to make a decision regarding surgery?
       Avascular necrosis is a progressive condition.  Progression may be observed as early as one month or it may take several months.
       Progression usually occurs in less than 20 months.

3. If I have avascular necrosis, can both hips be operated on at the same time?
      In general, after performing one vascularized fibular graft and the unoperated hip is symptomatic then the second hip surgery is three 
      months later.

4. How long does the surgery take?
      The surgical procedure lasts approximately four hours.  You are under anesthesia approximately five hours.

5. How long will it take to recuperate?
      Recuperation is somewhat variable and depends on the individual .  Some feel like their health and strength returns one week after surgery 
      and others four to six weeks following surgery.

6. How often do I need to return to Duke for follow-up visits?
     It is only necessary for you to come to Duke one year after surgery.
     your local orthopaedist can see you at six weeks, three months, and six

7. What happens to the lower leg after the fibula bone is removed?
     The fibula is not a weight bearing bone but acts as strut for mucsle attachment.   The middle portion of the bone is removed leaving the top
     and bottom to the bone without change.  No plating is required and there is no change in the appearance of the lower leg except for the 
     incision on the outside of the leg.

8. What kind of therapy will I have following surgery?
     Physical therapy is only necessary while in the hospital.  The exercises described in the handbook can be used as long as one wishes to
     postoperatively.  Swimming and stationary bicylcing are highly recommended after the first 6 weeks from surgery.

9. Will I be on any medication postoperatively?
     Anticoagulation in the form of Aspirin, Persantine (dipyridamole), Dextran are given postoperatively.  Dextran is  given to you while in the
     hospital over a five day period.  The aspirin and Persantine are taken for six weeks, and there are no precautions necessary at that time.
     Sometimes an iron supplement is prescribed  postoperatively.

- The Author:
    - this manuscipt was prepared by Eunice Gunneson P.A.

Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips.