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Drawbacks Current TechniquesNonetheless, vascularizedfibular grafts have several drawbacks. Their use as freetissue transfers is challenging, as microsurgical techniques arerequired. Prolonged operative times and extensive dissectionpose risks to the recipient site and increased morbidity to thedonor site. A well-vascularized bed, adequate soft-tissue coverand absence of infection are required, but even if these conditionsexist the transported fibula is unlikely to enlarge sufficientlyin width to equal the dimensions of the original bone, particularlywith femoral replacement.113e115 Although bone union isachieved in the majority of cases116 the fracture rate of this graft,even in the upper non-weight-bearing extremity, is more than30e50%.117e119Finally, in the case of unsuccessful incorporationof the graft both host and donor sites are compromised.120

(Lasanianos, N. G., Kanakaris, N. K., & Giannoudis, P. V. (2009). Current management of long bone large segmental defects. Orthopaedics and Trauma, 24(2), 149–163. http://doi.org/10.1016/j.mporth.2009.10.003)  

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