Medical Modeling for Precision Ulna Reconstruction Using a Microvascular Fibula Free Flap.

Abstract

Despite the growing use of medical modeling in other surgical specialties, its utilization in extremity reconstruction has remained limited. We present the application of medical modeling for ulna reconstruction using a microvascular fibula free flap. Following a motor vehicle accident, the patient suffered segmental loss of the right radius and ulna with concomitant forearm soft tissue and muscle loss. Using medical modeling, imaging from the unaffected contralateral forearm and lower extremity was used to plan a reconstruction that restored the anatomic length and orientation of the ulna. Accurate ulna length was recreated from the contralateral ulna, which served as a template. Cutting guides for the osteotomies on both the fibula and ulna maximized surface contact at the native ulna and fibula junction to aid in osseous healing of the fibula flap, stabilized the fibula orientation on the ulna, and allowed for lag screw placement for additional fixation.