Vascularized and Non-vascularized Fibula Grafts in Tumour Reconstruction: Single Centre Experience With Mid to Long-term Results

Abstract

Background/Aim: Vascularized (VFG) and nonvascularized fibula grafts (NVFG) are used in reconstruction of bone defects after tumour resection. This study compared both autografts and their results, risk factors, and complications. Patients and Methods: Tumour resection and reconstruction by using VFG (n=17) and NVFG (n=36) were performed in 53 patients at our institute (range=3-65 years of age, mean: 21.2 ± 13.2 years) of which 24 were female. Malignant tumours were diagnosed in 26 patients (VFG=16 patients-94%). The mean follow-up was 14.9 years (range=1.5-43 years). Factors like consolidation, functional and oncologic outcomes, and complications were analysed. Results: In total, 75 struts of fibula were obtained. The mean length of the fibula was 16.3 cm (16 in NVFG and 16.5 in VFG). The mean union time was 13 months (6 to 25 months) overall. Hypertrophy was found in 65 of 75 grafts (86.7%) and consolidation was found in 69 (92%). Hypertrophy was similar in VFG (85.3%) and NVFG (87.1%). Complication rate in VFG was 41% and in NVFG 25%. Fractures were found in 7 (13%), infections in 4 (7.5%), and non-union in 5 (9.4%) patients. Chemotherapy was the only negative prognostic factor for union time (p=0.021). Conclusion: Both VFG and NVFG are used with successful results in the reconstruction of segmental bone tumour defects. With lower complication rates, NVFG showed comparable results to VFG but is limited in indication by size for greater defects, and malignant tumours. Chemotherapy is an adverse factor leading to prolonged union time in both techniques.

Cross-beam Non-vascular Fibular Graft Reconstruction in the Management of Long Bone Giant Aneurysmal Bone Cyst – A Case Series

“…In these conditions, compared to vascularized fibular graft that demands surgical expertise with significant donor site morbidity, non-vascularized fibular grafts are a good option for reconstruction of the void arising from extended curettage of the lesion [ 19 , 25 ]. Furthermore, vascularized fibular graft needs an extensive approach with increased operating time which may increase the risk of other complications [ 29 ]. The geometric orientation of the non-vascularized fibula is of great importance to maintain the anatomic structural integrity of the void developed from the curettage.…”