Vascularized Free Fibula Transfer for Oncologic Reconstruction of the Humerus

Abstract

Reconstruction of the humerus after oncologic resection is challenging. Vascularized free-fibula transfer allows the potential for rapid autograft incorporation in areas compromised by radiation, chemotherapy, and resection. A retrospective case series of vascularized free-fibula transfers for humeral reconstructions is reported. Fifteen patients were identified; nine had surgery for glenohumeral arthrodesis (three primary fusions, six salvage/revision), four had surgery for intercalary defects (three primary reconstructions, one salvage), one patient had an onlay graft for a pathologic fracture in irradiated bone, and one patient had an osteoarticular graft. Average followup was 68 months. One patient died from disease 41 months after surgery. Oncologic outcome was excellent with no local recurrence and preservation of all limbs. There were an average of 0.8 major complications (requiring reoperation) and 0.5 minor complications per patient. The most frequent complication was fracture, occurring in six of 15 patients. All patients went on to bony union except two patients with glenohumeral arthrodesis with asymptomatic fibrous unions. Mean time to union was 12 months. Vascularized free fibula transfer provides an effective and successful means of limb-preserving reconstruction after oncologic resection of the humerus. Healing time may be prolonged, and refracture and other complications commonly are encountered. Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence.