Download PDF
J Reconstr Microsurg 2005; 21(2): 79-84
DOI: 10.1055/s-2005-864839
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Free Vascularized Fibula Grafts in Limb-Salvage Surgery

Rob Pollock1 , Paul Stalley1 , Ken Lee2 , David Pennington2
  • 1Departments of Orthopaedic Surgery, Royal Prince Alfred Hospital, Missenden Rd, Sydney, Australia
  • 2Department of Plastic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
Further Information

Publication History

Accepted: September 21, 2004

Publication Date:
28 February 2005 (online)

    Permissions and Reprints

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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 9 Wood M B. Upper extremity reconstruction by vascularised bone transfers: results and complications.  J Hand Surg. 12A 422-427
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Enneking W F. A system of staging musculoskeletal neoplasms.  Clin Orthop. 1986;  204 9-24
    PubMedGoogle Scholar
  • 19 Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumour of bone.  J Bone Joint Surg. 1987;  69A 106-114
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    Google Scholar
  • 24 de Boer H H, Wood M B. Bone changes in the vascularised fibular graft.  J Bone Joint Surg. 1989;  71B 374-378
    PubMedGoogle Scholar
  • 25 Araki N, Myoui A, Kuratsu S et al.. Intraoperative autogenous irradiated bone grafts in tumor surgery.  Clin Orthop. 1999;  368 196-206
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar

Rob PollockFRCS 

31 Munster Road, London SW6 4ER, United Kingdom

      >