Long-Term Follow-Up of Free Vascularized Fibular Head Graft for Reconstruction of the Proximal Humerus After Wide Resection for Bone Sarcoma

Abstract

Long-term follow-up of humerus reconstruction by FVFHG showed no deterioration in upper limb function despite the risk of fibular head resorption. FVFHG of the proximal humerus is a reconstruction technique that can provide good long-term upper limb function.

Mid- to long-term effects of two different biological reconstruction techniques for the treatment of humerus osteosarcoma involving caput humeri

“…Most patients experienced one or more major complications such as caput humeri absorption or fracture; thus, the abductor mechanism was disrupted in almost all of these patients. Although excellent long-term outcomes were rare in our series, a flail shoulder is often the best alternative for the patient who does not need to use the hand in space; the same was reported by other authors [7][8][9][10][11][12][13][14][15][16][17]23]. We also find that functions of the elbow, wrist, and hand remained in a flail limb and can meet the requirements of daily life with the help of an orthotic or the contralateral hand.…”

“…Optimal methods for shoulder reconstruction after resection of the proximal humerus including caput humeri are controversial and challenging [2], especially in skeletally immature patients or massive bone resected, due to the narrow medullary canal, small length of the remaining bone, poor compliance in immobilization, and less soft tissue available for coverage [8,9]. Currently, commonly used reconstructive options following caput humeri resection include preservation of the mobile glenohumeral joint using a prosthesis, osteoarticular allograft or allograft prosthesis composite, fibular or autoclaved humeral autograft, and the clavicula pro humero procedure [10][11][12][13]. The reconstruction method is often determined by factors such as the patients' economic status, the tumor type and extension, the surgeon's skills, and the availability of instruments [5].…”

“…Theoretically, biological reconstruction has merits such as creating bone stock for possible future revision, and the attachment of remaining deltoid muscle and rotator cuff tendons to the soft tissue of the graft provides better stability and active range of motion of the shoulder, which should lead to a better overall function and higher patient satisfaction. Yet, numerous studies have reported high rates of major complications including fracture, nonunion, subchondral collapse, and infection, which often require removal or revision of the osteoarticular graft [9][10][11][12][13][14][15][16][17].…”

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

“…Another validated questionnaire given to evaluate physical function is the Toronto Extremity Salvage Score (TESS) which was developed specifically to assess patients undergoing limb preservation surgery for tumors of the extremities. In our systematic review, we found that only five studies reported TESS scores, while only one study reported DASH scores . Thus, we did not attempt to quantify patient‐centered outcomes based on DASH or TESS scores.…”

“…In our systematic review, we found that only five studies reported TESS scores, while only one study reported DASH scores. 4,20,23,27,39,64 Thus, we did not attempt to quantify patient-centered outcomes based on DASH or TESS scores.…”