Free Vascularized Fibular Graft Transfer in the Reconstruction of Defects for Premalignant and Malignant Musculoskeletal Conditions of the Femur in a Tertiary Care Setting in Pakistan: A Series of Six Cases.

Avais Raja,Waqar Jan,Mamoon Rashid,Imad-Ud-Din Saqib,Hana Manzoor

doi:10.7759/cureus.863

Abstract

ObjectiveTo determine the application, success and complications of the utilization of free vascularized fibular grafts (FVFG) in the reconstruction of lower limb defects after resection of primary lower limb musculoskeletal tumors.MethodologyThis descriptive retrospective case series analysis was conducted at Shifa International Hospital from January 2011 to January 2016. It included patients who had premalignant and malignant conditions of the lower limb and subsequently had the lesion resected followed by FVFG surgery. The data collected was to outline the demographic profile, clinical features, and post-procedure outcomes and complications.ResultsThere was a total of six patients. The mean age of the patients was 25.8 ± 11.8 years (range: 15-40 years). The patients presented with pain, swelling, inability to bear weight and/or restriction of movement at the joint. Postoperatively, one patient had proximal wound necrosis and one patient had a thrombus in the anastomosed vessels, both of which were managed successfully.ConclusionWith a success rate of 100% at the end of the six-month follow-up period, FVFG surgery is a reliable procedure that may be successfully carried out for musculoskeletal tumors of the lower limb with minimal complications.

Highlights

A free vascularized fibular graft (FVFG) is a graft containing tissue and/or bone of the fibular region with its vascular pedicle that is attached to a recipient site for reconstruction of bone defects [1]
FVFG has been utilized for the treatment of bony defects resulting from congenital anomalies, infection, tumors, avascular necrosis of the femoral head, and traumatic salvage procedures [3]
We conducted a case series analysis where a FVFG was used to fill in the intercalary defect in the femur after a wide resection of various premalignant and malignant conditions

Summary

Introduction

A free vascularized fibular graft (FVFG) is a graft containing tissue and/or bone of the fibular region with its vascular pedicle that is attached to a recipient site for reconstruction of bone defects [1]. FVFG has been utilized for the treatment of bony defects resulting from congenital anomalies, infection, tumors, avascular necrosis of the femoral head, and traumatic salvage procedures [3]. Many patients with premalignant and malignant bone tumors undergo wide resection to decrease risk of local recurrence only to leave a large bony defect behind [4,5]. Vascularized bone grafts carry the advantage of reconstructing large bony defects due to their independent blood supply that allows integration of the graft into the host with a high union rate [6]. We conducted a case series analysis where a FVFG was used to fill in the intercalary defect in the femur after a wide resection of various premalignant and malignant conditions

Methods

Discussion

Conclusion