Composite extremity and trunk reconstruction with vascularized fibula flap in postoncologic bone defects: A 10-year experience

BACKGROUND: Obtaining good functional outcomes with reconstruction following resection of primary bone tumors of the trunk and extremities is a significant challenge. The authors present their reconstructive experience using vascularized fibula flap transfer to improve bone healing and optimize functional outcomes. METHODS: From 2001 to 2010, 52 consecutive patients received 53 fibula flaps for trunk (n = 19), lower extremity (n = 21), and upper extremity (n = 13) composite reconstructions. RESULTS: Extremity segmental bone defects were repaired using an intramedullary (n = 14) or onlay technique (n = 20), and pelvic ring defects were repaired using double-barrel struts (n = 16). There were three spinal defect reconstructions. Growth plate transfer with vascularized fibula was used in pediatric patients (n = 5). The mean follow-up time was 36.8 months. There were no flap losses. Complications included delayed wound healing (7.5 percent), infection (1.8 percent), and hardware failure (1.8 percent). Bony unions were achieved in 94.3 percent of patients, with a mean time of 2.8 months (range, 1.5 to 5 months) to initial bony bridging and 5.4 months (range, 1.5 to 12 months) to final bony union. All upper extremity patients were able to use their reconstructed limb. All trunk and lower extremity patients were able to ambulate. CONCLUSION: Reconstructions with vascularized fibula flaps can result in a high rate of bone union and short healing time, facilitate early ambulation, provide good functional outcomes, improve quality of life, and avoid debilitating amputations.