Free Vascularized Fibular Graft With LISS Plate for the Bone Defects of the Femur After Tumor Resection

Abstract

Background: Various methods for reconstructing large femur bone defects after tumor resection have been introduced. In this study, we reviewed the clinical outcomes of using a one-barrel free vascularized fibular graft (FVFG) protected by a less invasive stabilization system (LISS) plate for lesions not involving the joint. Methods: Between August 2007 and August 2013, we treated 7 patients with large femoral bone defects after tumor resection. The mean age of the patients was 19 years (range, 12-36 years), and 3 were women. All were diagnosed preoperatively with osteosarcoma. Femoral bone defects were reconstructed using an in-lay strut FVFG following a LISS femoral plate. The mean bone defect size was 10.5 cm (range, 6-16 cm). We reviewed clinical outcomes at the last follow-up. Result: All patients survived beyond the last follow-up; the mean follow-up period was 54 months (range, 26-100 months). Two patients (28.5%) sustained stress fractures of the FVFG, but the LISS plate protected the fractured graft until in situ bone healing occurred. One case of metal failure of the LISS plate was encountered; the plate was replaced with a longer one, which achieved bone union. Mean time to bone union of both host-graft junctions was 24 months (range, 18-31 months). The mean Musculoskeletal Tumor Society score (%) was 85.8% (range, 80-95%). Conclusion: A one-barrel FVFG protected by a LISS plate maintained a stable graft-host bone construct, successfully leading to bone union, even in cases of stress fractures of the graft, and appears to be a good option for large femur bone defects after tumor resection.