Free vascularized fibula grafting in the operative treatment of malignant bone tumors of the upper extremity: A systematic review of outcomes and complications

Landau, Mark J.; Badash, Ido; Yin, Christine; Alluri, Ram K.; Patel, Ketan M.

doi:10.1002/jso.25032

Cited by 39 publications

(44 citation statements)

References 95 publications

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“…Since the very low incidence rate of forearm, Daecke [12] summarized 33 cases of osteosarcoma through multicenter study of Cooperative Osteosarcoma Study Group (COSS), which found 60.6% of the tumors in distal radius and only one tumor in proximal ulna. The common tumors of forearm bone are osteosarcoma, Ewing's sarcoma, undifferentiated pleomorphic sarcoma and chondrosarcoma, which are consistent with that osteosarcoma was the most common tumor in upper limb reported by Landau [13]. But Ewing's sarcoma and chondrosarcoma were usually sporadic and individual cases [8,[14][15][16].…”

Section: Discussionsupporting

confidence: 68%

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What Are the Results of Limb Salvage Surgery for Primary Malignant Bone Tumor in the Forearm?

Liu

Yang

Jin

et al. 2020

Preprint

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Background The forearm primary malignant bone tumor is rare and limb salvage is difficult. The purpose of this study was to analyze epidemiological characteristics of forearm primary malignant bone tumors and to explore oncological and functional results of limb salvage surgery in forearm.Methods 369 patients with primary forearm malignant bone tumors were retrospectively analyzed from 2000 to 2017. There were 266 patients with radius tumor and 46 (17.3%) of them were malignancy, while 103 patients with ulna lesion and 22 (21.4%) of them were malignant tumor. The oncological results, prognostic factors and functional results after limb salvage surgery of forearm malignancy were analyzed.Results A total of 60 patients received limb salvage surgery. Fifty-six patients followed more than 12 months or progressions within 12 months were included in final evaluation. Radius resection was performed in 38 patients and distal radius (25 patients) was most frequent. Ulna resection was performed in 18 patients and proximal ulna (13 patients) was most frequent. The surgical margin contained intracapsular resection in 3 patients, marginal resection in 8 patients and wide resection in 45 patients. The follow-up averaged 72.1 (7-192, median 62.5) months. Local recurrence occurred in 11 patients (19.6%) and distant metastasis occurred in 14 patients (25%). The 5-year recurrence free survival rates was 79.8%. Univariate analysis showed history of unplanned resection, tumor located in ulna, tumor located in proximal forearm and inadequate surgical margin were associated with recurrence. The overall 5-year and 10-year survival rates were 83.5% and 71.7%, respectively. Univariate analysis showed inadequate surgical margin, local recurrence and distant metastasis were associated with death. Forty-two patients were evaluated by MSTS score with an average of (93.0 ± 5.1) %.Conclusions The incidence of radius malignant tumor is higher than that of ulna. The distal radius and proximal ulna are most frequency involved sites. Unplanned resection, tumor located in ulna, tumor located in proximal forearm and inadequate surgical margin are risk factors for local recurrence; local recurrence and distant metastasis are independent prognostic factors of death. The oncology control and function result of limb salvage surgery was satisfactory.

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Section: Discussionsupporting

confidence: 68%

“…Tumors located in ulna and proximal forearm showed signi cantly higher risk of local recurrence in univariate analysis, which was not found in previous studies [7,12,13]. It is considered that soft tissue sarcoma of forearm has been reported in majority before, so tumor size was more concerned and was associated with recurrence [19].…”

Section: Discussionmentioning

confidence: 69%

What Are the Results of Limb Salvage Surgery for Primary Malignant Bone Tumor in the Forearm?

Liu

Yang

Jin

et al. 2020

Preprint

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“…Complication rates of vascularized fibula grafts have been reported to be 7%-35% and 3.3%-23.1% in several cases (23,25). Although no serious complication was seen in our patients, two of them were treated early due to superficial infection.…”

Section: Discussionmentioning

confidence: 47%

Is Non-Vascularized Fibular Grafting an Effective Choice in the Treatment of Upper Extremity Pseudarthrosis?

Ekinci¹

2020

Erciyes Med J

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To examine the efficacy of non-vascularized fibular grafts (NVFGs) in cases of isolated upper extremity pseudarthrosis, a subject covered by few publications in the literature. Materials and Methods: Twelve long bones of 11 patients treated with NVFGs for upper extremity pseudarthrosis between January 2014 and July 2018 in our clinic were included in this study. Demographic data, length of the NVFG, postoperative complications, postoperative recovery period, radiographic bone union, joint range of motion measurements, Quick-Disabilities of the Arm, Shoulder and Hand (Q-DASH) score for functional evaluation, and Lower Extremity Functional Scale (LEFS) or donor site morbidity were recorded. Results: Of the 11 cases (three females and 8 males; median age 42.5 years; range 11 to 54 years; mean follow up 24.58±9.31 months), five cases involved the humerus, three cases involved the radius, two cases involved the ulna, and two cases involved the clavicle. The mean amount of graft harvested from the donor site was 39.7±8.87 mm, while the graft union time was 6±0.50 months. Satisfactory Q-DASH [median 6.8 (2.28-29.50)] and LEFS scores (mean 76.5±2.81) were obtained Conclusion: Reconstruction with NVFGs is still an effective method in patients with problematic treatment of upper extremity long bone pseudarthrosis.

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“…Graft nonunion was most common (24.1%), occurring in four malignant bone tumors, two cases of pseudoarthrosis, and one case of osteomyelitis. Although the literature on the effect of chemotherapy on nonunion in FVFG is mixed, 22,31,[38][39][40][41][42] in our own series, more than half of the cases of nonunion occurred in patients receiving chemotherapy. In remaining the malignant bone tumor patients, chemotherapy also appeared to lead to slower rates of bony union (average of 7.5 months).…”

Section: Discussionmentioning

confidence: 51%

Surgical Outcomes, Complications, and Long-Term Functionality for Free Vascularized Fibula Grafts in the Pediatric Population: A 17-Year Experience and Systematic Review of the Literature

McCullough

Arkader

Ariani

et al. 2020

J Reconstr Microsurg

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Background In the pediatric population, bony defects of the extremities pose a significant challenge for which free vascularized fibular grafts (FVFGs) represent a valuable reconstructive option. The purpose of this study was to explore surgical outcomes, complications, and long-term functionality of FVFG for this patient group. Methods Using MEDLINE and PubMed databases, studies were identified of pediatric extremity reconstruction using FVFG which reported functional outcomes and/or complications. The operative logs at a tertiary pediatric center were then reviewed for cases of FVFG between January 2000 and 2017. Demographic characteristics, surgical indications, operative details, graft survival, bony union, complications, and functionality of the reconstruction were recorded. Results A total of 366 studies were identified with 23 ultimately meeting inclusion criteria in the systematic review. In the institutional series, 29 patients were included with mean age of 9.7 years (1–17 years). Indications for reconstruction included malignant bone tumor (n = 11), osteomyelitis (n = 9), congenital pseudoarthrosis (n = 6), and osteofibrous dysplasia (n = 3). Major postoperative complications included graft nonunion (24.1%), fracture (17.2%), and hardware failure (17.2%). Thirteen patients (44.8%) experienced delayed complications, while two (6.8%) experienced an immediate complication. Complications occurred in the donor site in 2 cases and the recipient site in all 13 cases. Long-term graft survival was achieved in 27 patients (93.1%), and 23 (79.3%) had full functional recovery, with an average Musculoskeletal Tumor Society score of 90% (60–100%). Mean follow-up was 5.17 years (2–12 years). Conclusion This review and institutional series demonstrate the versatility of FVFG to facilitate limb reconstruction in large defects or serve as a salvage option in complex cases. While immediate and donor-site complications are uncommon, delayed recipient-site complications are frequent, and patients and families should be counseled regarding this expectation. Though technically challenging, excellent long-term graft viability and functional recovery can be achieved in the large majority of patients.

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Free vascularized fibula grafting in the operative treatment of malignant bone tumors of the upper extremity: A systematic review of outcomes and complications

Cited by 39 publications

References 95 publications

What Are the Results of Limb Salvage Surgery for Primary Malignant Bone Tumor in the Forearm?

What Are the Results of Limb Salvage Surgery for Primary Malignant Bone Tumor in the Forearm?

Is Non-Vascularized Fibular Grafting an Effective Choice in the Treatment of Upper Extremity Pseudarthrosis?

Surgical Outcomes, Complications, and Long-Term Functionality for Free Vascularized Fibula Grafts in the Pediatric Population: A 17-Year Experience and Systematic Review of the Literature

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