A Comparison of Vascularized Free Fibular Flaps and Nonvascularized Fibular Grafts for Reconstruction of Long Bone Defects after Tumor Resection

Abstract

The use of the fibula autograft has been a reliable method in the reconstruction of long bone defects after tumor resection. The objective of this study was to report the outcomes fibular grafting in terms of graft union, functional score, complications, and oncologic outcome. A retrospective review of patients with fibular grafting after tumor resection was done from January 1, 1993 to December 31, 2013. The primary outcome was graft union and the revised musculoskeletal tumor society scoring system (MSTS score). The secondary outcomes were oncologic outcomes, complications, and the factors associated with graft union. A total of 52 patients with a mean follow-up of 42 months (SD, 33; range, 12-132 months) were included. The overall union for all fibular grafts was 37 of 52. The use of vascularized free fibula flaps had a higher union rate compared with nonvascularized fibula grafts. The use of a vascularized free fibular flap was four times likely to unite (95% CI 1.1-12.8, = 0.039) compared with nonvascularized fibular grafts. The mean MSTS score in 36 patients was 82.5 (SD, 12.9) at 35 months from surgery (SD, 30). A total of 39 complications were present in 29 patients. On final follow-up, 45 of 52 patients were alive, six patients had died of disease and one died of other causes. A higher union rate was achieved using vascularized free fibular flaps compared with nonvascularized fibular grafts for long bone reconstruction after tumor resection. There was no difference in terms of MSTS score between the two types of grafts.

Long-term follow-up of fibular graft for the reconstruction of bone defects

“…[ 8 ] Free vascularized fibular grafts achieve higher union rate than non-vascularized fibular grafts in the reconstruction of long bone defects. [ 9 – 25 ]…”

Reconstruction of mandibular defects using vascularized fibular osteomyocutaneous flap combined with nonvascularized fibular flap

“…Giordano et al (13) harvested a 21 cm of NVFF and divided it into 9 cm and 12 cm approximately, which were then used to successfully repair the distal femoral condyle defect in a 86-year-old patient caused by a comminuted fracture of the distal femur. Compared with vascularized fibular graft, NVFF is associated with a certain risk of failure, but the above-mentioned successful cases also indicate that, it is feasible to the reconstruct bone defects using NVFF in the clinic (14).…”

“…However, the NVFF was used as the upper bone mass to increase the alveolar ridge height, which was linked with a relatively weak anti-infective ability in this surgical procedure. Typically, a decohesion in the oral mucosa would likely cause failure of the above nonvascularized fibula transplantation (14). In the current study, primary tumor resection and fibular flap preparation were performed simultaneously, and oral mucosa and submucosal tissue were sutured immediately after tumor resection by a team.…”

Lengthening of free fibular grafts for reconstruction of the residual leg length discrepancy

“…Free fibular grafting is considered as one of the standard salvage procedures for reconstructing segmental skeletal defect [25, 26]. Using free vascularized bone grafts generates better results than using non-vascularized bone grafts [27]. A vascularized osseous transfer has several advantages during the early process of bone repair, including an enhanced union capacity, the potential for subsequent osseous hypertrophy and greater strength [28].…”