Free Vascularized Fibula Grafts in Limb-Salvage Surgery

ABSTRACT

The authors review the outcome of a consecutive series of 24 free vascularized fibular grafts performed as part of a limb-salvage procedure following tumor excision. There were 15 women and nine men with a mean age of 26 years (range: 6 to 52 years). The minimum follow-up was 12 months. The mean length of the graft was 13.1 cm. (range: 4.5 to 25 cm). Fifteen grafts were used in the upper limb, eight in the lower limb, and one in the pelvis. Bony union was achieved in 21/24 patients at a mean of 9.3 months. Complications occurred in 13/24 patients of whom 11 required a second operation. Four patients died of metastatic disease. The mean Musculoskeletal Tumor Society (MSTS) functional score in the remaining 20 was 84.5 percent, with 16 patients having a good or excellent outcome.

Free vascularized fibula grafts offer a reliable method of reconstruction after excision of bone tumors. Although the incidence of complications appears high, they are relatively easy to correct, bony union is achieved in the majority, and functional outcome is good.

KEYWORDS

Free vascularized fibula grafts - limb-salvage surgery - tumor excision

REFERENCES

• 1 Hsu R W, Wood M B, Sim F H, Chao E Y. Free vascularised fibula grafting for reconstruction after tumour resection.  J Bone Joint Surg. 1997;  79B 36-42
• 2 Minami A, Kasashima T, Iwasaki N, Kato H, Kaneda K. Vascularised fibula grafts. An experience of 102 patients.  J Bone Joint Surg. 2000;  82B 1022-1025
• 3 Minami A, Kutsumi K, Takeda N, Kaneda K. Vascularised fibular graft for bone reconstruction of the extremities after tumor resection in limb-saving procedures.  Microsurgery. 1995;  16 56-64
• 4 Chew W Y, Low C K, Tan S K. Long-term results of free vascularised fibular graft. A clinical and radiographic evaluation.  Clin Orthop. 1995;  311 258-261
• 5 Aberg M, Rydholm A, Holmberg J, Wieslander J. Reconstruction with a free vascularised fibula graft for malignant bone tumor.  Acta Orthop Scand. 1988;  59 430-437
• 6 Shea K G, Coleman D A, Scott S M, Coleman S S, Christianson M. Microvascularized free fibula grafts for reconstruction of skeletal defects after tumor resection.  J Pediatr Orthop. 1997;  17 424-432
• 7 Ihara K, Doi K, Yamamoto M, Kawai S. Free vascularised fibular grafts for large bone defects in the extremities after tumor excision.  J Reconstr Microsurg. 1988;  14 371-376
• 8 Nagoya S, Usui M, Wada T, Yamashita T, Ishii S. Reconstruction and limb salvage using a free vascularised fibular graft for periacetabular malignant bone tumours.  J Bone Joint Surg. 2000;  82B 1121-1124
• 9 Wood M B. Upper extremity reconstruction by vascularised bone transfers: results and complications.  J Hand Surg. 12A 422-427
• 10 Gao Y H, Ketch L L, Eladoumikdachi F, Netscher D T. Upper limb salvage with microvascular bone transfer for major long-bone segmental tumor resections.  Ann Plast Surg. 2001;  47 240-246
• 11 Ono H, Yajima H, Mizumoto S, Miyauchi Y, Mii Y, Tamai S. Vascularized fibular graft for reconstruction of the wrist after excision of giant cell tumour.  Plast Recontr Surg. 1997;  99 1086-1093
• 12 Bajec J, Gang R K. Bone reconstruction with a free vascularised fibular graft after giant cell tumour resection.  J Hand Surg. 1993;  18B 565-567
• 13 Usui M, Murakami T, Naito T, Wada T, Takahashi T, Ishii S. Some problems in wrist reconstruction after tumor resection with vascularised fibular-head graft.  J Reconstr Microsurg. 1996;  12 81-88
• 14 Arai K, Toh S, Tsubo K, Nishikawa S, Narita S, Miura H. Complications of vascularised fibula graft for reconstruction of long bones.  Plast Reconstr Surg. 2002;  109 2301-2306
• 15 Lee E H, Goh J C, Helm R, Pho R W. Donor site morbidity following resection of the fibula.  J Bone Joint Surg. 1990;  72B 129-131
• 16 Vail T P, Urbaniak J R. Donor-site morbidity with use of vascularised autogenous fibular grafts.  J Bone Joint Surg. 1996;  78A 204-211
• 17 Babovic S, Johnson C H, Finical S J. Free fibula donor-site morbidity: the Mayo experience with 100 consecutive harvests.  J Reconstr Microsurg. 2000;  16 107-110
• 18 Enneking W F. A system of staging musculoskeletal neoplasms.  Clin Orthop. 1986;  204 9-24
• 19 Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumour of bone.  J Bone Joint Surg. 1987;  69A 106-114
• 20 Yoshimura M, Shimamura K, Iwai Y, Yamauchi S, Ueno T. Free vascularised fibular transplant. A new method for monitoring circulation of the grafted fibula.  J Bone Joint Surg. 1983;  65A 1295-1301
• 21 Hong A, Stevens G, Stalley P et al.. Extracorporeal irradiation for malignant bone tumours.  Int J Radiat Oncol Biol Phys. 2001;  50 441-447
• 22 Enneking W F, Dunham W, Gebhardt M C, Malawar M, Pritchard D J. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system.  Clin Orthop. 1993;  286 241-246
• 23 W Enneking F. Modification of the system for functional evaluation of surgical management of musculoskeletal tumors. In Enneking WF Limb Salvage in Musculoskeletal Oncology. New York; Churchill-Livingstone 1987: 626
• 24 de Boer H H, Wood M B. Bone changes in the vascularised fibular graft.  J Bone Joint Surg. 1989;  71B 374-378
• 25 Araki N, Myoui A, Kuratsu S et al.. Intraoperative autogenous irradiated bone grafts in tumor surgery.  Clin Orthop. 1999;  368 196-206
• 26 Chen W, Chen T, Huang C, Chiang C, Lo W. Treatment of malignant bone tumours by extracorporeally irradiated autograft-prosthetic composite arthroplasty.  J Bone Joint Surg. 2002;  84B 1156-1161
• 27 Sabo D, Bernd L, Buchner M. Intraoperative extracorporeal irradiation and replantation in local treatment of primary malignant bone tumors.  Orthopade. 2003;  32 1003-1012
• 28 Bohm P, Fritz J, Thiede S, Budach W. Reimplantation of extracorporeal irradiated bone segments in musculoskeletal tumor surgery: clinical experience in eight patients and review of the literature.  Langenbecks Arch Surg. 2003;  387 355-365