The combination of a vascularized fibula with a massive allograft for reconstruction after intercalary resection of long bone tumor in extremities

Abstract

Objective To investigate the effects of combined use of an allograft and vascularized fibular flap for the reconstruction of bone defects after intercalary resection of long bone malignancy.Methods From April 2006 to October 2009,19 patients that had intercalary resection of long bone malignancy (5 in humerus,7 in femur,7 in tibia)underwent reconstruction with an allograft and vascularized fibula construct,including 11 males and 8 females with an average age of 18.5 years.The average length of the defect was 13.2±4.3 cm.Free vascularized fibula flaps were used in 16 patients and ipsilateral pedicle vaseularized fibula grafts in 3.Time to union was recorded through evaluation of plain radiographs.Bone scan was used to evaluate the viability of the vascularized fibula.Patients were examined oncologically and radiographically and were assessed functionally with MSTS-93.Results The mean follow-up time was 27.5 months.The average length of the fibula flap was 17.9±5.2 cm.Viability of the fibular grafts was verified in all cases.The average time for bone union at allograft-host junction was 11.3±2.8 months in femur,14.1±3.3 in tibia,6.8±1.4 in humerus,respectively.The MSTS-93 average score at final follow-up was 95.2% in upper extremity and 91.8% in lower extremity.The oncology result in patients with follow-up more than 2 years was continuous disease free in 11 patients.no evidence of disease after recurrence following resection in 1,alive with tumor in 1,and died of lung metastasis in 1.Conclasion Vascularized fibular flap in combination with massive allograft provide an option for reconstruction of large bony defects after long bone malignancy extirpation.The viability of the fibula is a cornerstone in success of reconstruction that prevents allograft nonunion and result in decreased time to bone healing,leading to earlier patient's recovery of function. Key words: Fibula; Bone transplatation; Transplatation,homologous; Bone neoplasms; Extremities