The vascularised fibular graft for limb salvage after bone tumour surgery

Abstract

Vascularised fibular grafts (VFGs ) are a valuable surgical technique in limb salvage after resection of a tumour. The primary objective of this multicentre study was to assess the risk factors for failure and complications for using a VFG after resection of a tumour. The study involved 74 consecutive patients (45 men and 29 women with mean age of 23 years (1 to 64) from four tertiary centres for orthopaedic oncology who underwent reconstruction using a VFG after resection of a tumour between 1996 and 2011. There were 52 primary and 22 secondary reconstructions. The mean follow-up was 77 months (10 to 195). In all, 69 patients (93%) had successful limb salvage; all of these united and 65 (88%) showed hypertrophy of the graft. The mean time to union differed between those involving the upper (28 weeks; 12 to 96) and lower limbs (44 weeks; 12 to 250). Fracture occurred in 11 (15%), and nonunion in 14 (19%) patients. In 35 patients (47%) at least one complication arose, with a greater proportion in lower limb reconstructions, non-bridging osteosynthesis, and in children. These complications resulted in revision surgery in 26 patients (35%). VFG is a successful and durable technique for reconstruction of a defect in bone after resection of a tumour, but is accompanied by a significant risk of complications, that often require revision surgery. Union was not markedly influenced by the need for chemo- or radiotherapy, but should not be expected during chemotherapy. Therefore, restricted weight-bearing within this period is advocated.

Non-vascularised fibula grafts for reconstruction of segmental and hemicortical bone defects following meta- /diaphyseal tumour resection at the extremities

“…Hypertrophy rates for vascularised fibula reconstructions vary between 37% and 90% [1, 12, 15, 21, 28]. Additionally, significant differences between the hypertrophy rates at the upper and lower extremities have been described.…”

“…Bone tumours in the meta-/diaphyseal region of long bones are rare (<10%), and the reconstruction of emerging bone defects (segmental or hemicortical) are therefore challenging; however, the best treatment method has been unclear until recently [1, 2]. …”

“…after extracorporeal irradiation) [10], the induced membrane technique [11] or the use of vascularised or non-vascularised bone grafts [1, 12, 13]. …”

“…Advantages of this method compared to the use of vascularised autografts consist of the remodelling capacity at the donor site, an easier operative technique and a shorter operative time [13, 14]. However, since non-vascularised fibula grafts are thought to lack biological activity and have a high risk of resorption, vascularised fibula grafts have been more frequently used for defect reconstructions during the last 40 years [1, 12, 15]. To date, there are a few reports on defect reconstructions after bone tumour resection using non-vascularised fibulae, but most of these studies did not focus on the extremities or have a rather small cohort of patients [13, 16–20].…”

Effectiveness of Clavicula Pro Humero Reconstruction for Elderly Patients: Report of Two Cases

“…The literature looking into the factors affecting duration of bone union after CPH reconstruction is scarce. On the other hand, there was a report that bone union after vascularized fibular grafts was not markedly influenced by chemotherapy of radiotherapy [22]. Considering that CPH reconstruction was similar to vascularized fibular grafts at a point to preserve the blood supply of autologous bone graft, we thought that these additional therapies would not have much effect on bone union after CPH reconstruction although further studies would be needed.…”