The vascularized fibular graft in orthopaedic oncology: Own experience andreview of literature

Primary malignant bone tumors can be treated predominantly with limb salvag e. After resection of large articular segments adjacent to the dia- or meta physis of long bones modular endoprosthetic devices are most commonly used for reconstruction. In case non-vascularized corticocancellous bone is tran splanted in order to bridge extensive bone defects, the risk of pseudarthro sis and fracture of the donor bone is significantly higher in comparison to a free vascularized transplant. From 1988 until 1999 we treated 20 patients with extensive bone defects aft er resection of tumors affecting the upper and lower extremity using a vasc ularized fibular graft. In this retrospective analysis we collected the dat a focusing on bone integration and functional outcome. The graft union was classified according to the standards of the "International Symposium of Li mb Salvage" Evaluation of the functional outcome was quantified using the E nneking-score. The stabilisation of the transplant was obtained exclusively by plate fixat ion in the upper extremity. In 10 in a total of 12 patients the reconstruct ion using a vascularized fibula transfer was reinforced with an allograft i n the lower extremity. The functional evaluation score reached 73% of norma l function at the last follow-up. After 18 months the radiographic evaluati on of graft union was "excellent" in 75%, "good" in 11%, "fair" in 6% and " poor" in 9% according to the criteria of the ISOLS. Main complications were graft fracture in of 15% and pseudarthrosis in 14.3%. Reconstruction of extensive bone defects using free vascularized fibula gra fts are a demanding operative procedure. The procedure combines a biologic form of reconstruction with a legitimate expectation of good long term outc ome and a relatively low rate of complications.