Download PDF
J Reconstr Microsurg 2017; 33(03): 194-205
DOI: 10.1055/s-0036-1594299
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Emmanuel Pantaleon Estrella
1   Microsurgery Unit, Department of Orthopedics, University of the Philippines Manila, Manila, Philippines
,
Edward H. M. Wang
2   UP Musculoskeletal Tumor Unit, Department of Orthopedics, University of the Philippines Manila, Manila, Philippines
› Author Affiliations
Further Information

Publication History

26 June 2016

08 October 2016

Publication Date:
15 December 2016 (online)

    Permissions and Reprints

Abstract

Background 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.

Methods 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.

Results 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, p = 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.

Conclusion 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.

Keywords

fibula graft - tumor reconstruction - fibula tumor reconstruction
 

  • References

  • 1 Simon MA, Aschliman MA, Thomas N, Mankin HJ. Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur. J Bone Joint Surg Am 1986; 68 (9) 1331-1337
    CrossrefPubMedGoogle Scholar
  • 2 Wodajo FM, Bickels J, Wittig J, Malawer M. Complex reconstruction in the management of extremity sarcomas. Curr Opin Oncol 2003; 15 (4) 304-312
    CrossrefPubMedGoogle Scholar
  • 3 Weiland AJ, Phillips TW, Randolph MA. Bone grafts: a radiologic, histologic, and biomechanical model comparing autografts, allografts, and free vascularized bone grafts. Plast Reconstr Surg 1984; 74 (3) 368-379
    CrossrefPubMedGoogle Scholar
  • 4 El-Sherbiny M. Long term behavior of pedicled vascularized fibular grafts in reconstruction of middle and distal tibia after resection of malignant bone tumors. J Egypt Natl Canc Inst 2008; 20 (2) 187-195
    PubMedGoogle Scholar
  • 5 Brigman BE, Hornicek FJ, Gebhardt MC, Mankin HJ. Allografts about the knee in young patients with high-grade sarcoma. Clin Orthop Relat Res 2004; (421) 232-239
    PubMedGoogle Scholar
  • 6 Dick HM, Malinin TI, Mnaymneh WA. Massive allograft implantation following radical resection of high-grade tumors requiring adjuvant chemotherapy treatment. Clin Orthop Relat Res 1985; (197) 88-95
    PubMedGoogle Scholar
  • 7 Mankin HJ, Gebhardt MC, Jennings LC, Springfield DS, Tomford WW. Long-term results of allograft replacement in the management of bone tumors. Clin Orthop Relat Res 1996; (324) 86-97
    PubMedGoogle Scholar
  • 8 Upton J, Kocher MS, Wolfort FG. Reconstruction following resection of malignancies of the upper extremity. Surg Oncol Clin N Am 1996; 5 (4) 847-892
    CrossrefPubMedGoogle Scholar
  • 9 Wang J, Shen J, Dickinson IC. Functional outcome of arthrodesis with a vascularized fibular graft and a rotational latissimus dorsi flap after proximal humerus sarcoma resection. Ann Surg Oncol 2011; 18 (7) 1852-1859
    CrossrefPubMedGoogle Scholar
  • 10 Hariri A, Mascard E, Atlan F , et al Free vascularised fibular graft for reconstruction of defects of the lower limb after resection of tumour. J Bone Joint Surg Br 2010; 92 (11) 1574-1579
    PubMedGoogle Scholar
  • 11 Amr SM, El-Mofty AO, Amin SN, Morsy AM, El-Malt OM, Abdel-Aal HA. Reconstruction after resection of tumors around the knee: role of the free vascularized fibular graft. Microsurgery 2000; 20 (5) 233-251
    CrossrefPubMedGoogle Scholar
  • 12 Chen CM, Disa JJ, Lee HY , et al. Reconstruction of extremity long bone defects after sarcoma resection with vascularized fibula flaps: a 10-year review. Plast Reconstr Surg 2007; 119 (3) 915-924 , discussion 925–926
    CrossrefPubMedGoogle Scholar
  • 13 Hsu RWW, Wood MB, Sim FH, Chao EYS. Free vascularised fibular grafting for reconstruction after tumour resection. J Bone Joint Surg Br 1997; 79 (1) 36-42
    CrossrefPubMedGoogle Scholar
  • 14 Shea KG, Coleman DA, Scott SM, Coleman SS, Christianson M. Microvascularized free fibular grafts for reconstruction of skeletal defects after tumor resection. J Pediatr Orthop 1997; 17 (4) 424-432
    CrossrefPubMedGoogle Scholar
  • 15 Minami A, Usui M, Ogino T, Minami M. Simultaneous reconstruction of bone and skin defects by free fibular graft with a skin flap. Microsurgery 1986; 7 (1) 38-45
    CrossrefPubMedGoogle Scholar
  • 16 Eward WC, Kontogeorgakos V, Levin LS, Brigman BE. Free vascularized fibular graft reconstruction of large skeletal defects after tumor resection. Clin Orthop Relat Res 2010; 468 (2) 590-598
    CrossrefPubMedGoogle Scholar
  • 17 Başarir K, Selek H, Yildiz Y, Sağlik Y. [Nonvascularized fibular grafts in the reconstruction of bone defects in orthopedic oncology]. Acta Orthop Traumatol Turc 2005; 39 (4) 300-306
    PubMedGoogle Scholar
  • 18 Krieg AH, Hefti F. Reconstruction with non-vascularised fibular grafts after resection of bone tumours. J Bone Joint Surg Br 2007; 89 (2) 215-221
    PubMedGoogle Scholar
  • 19 Krieg AH, Lenze U, Gaston MS, Hefti F. The outcome of pelvic reconstruction with non-vascularised fibular grafts after resection of bone tumours. J Bone Joint Surg Br 2010; 92 (11) 1568-1573
    CrossrefPubMedGoogle Scholar
  • 20 Enneking WF, Eady JL, Burchardt H. Autogenous cortical bone grafts in the reconstruction of segmental skeletal defects. J Bone Joint Surg Am 1980; 62 (7) 1039-1058
    CrossrefPubMedGoogle Scholar
  • 21 Lawal YZ, Garba ES, Ogirima MO , et al. Use of non-vascularized autologous fibula strut graft in the treatment of segmental bone loss. Ann Afr Med 2011; 10 (1) 25-28
    CrossrefPubMedGoogle Scholar
  • 22 Chadha M, Arora SS, Singh AP, Gulati D, Singh AP. Autogenous non-vascularized fibula for treatment of giant cell tumor of distal end radius. Arch Orthop Trauma Surg 2010; 130 (12) 1467-1473
    CrossrefPubMedGoogle Scholar
  • 23 Abuhassan FO, Shannak A. Non-vascularized fibular graft reconstruction after resection of giant aneurysmal bone cyst (ABC). Strateg Trauma Limb Reconstr 2010; 5 (3) 149-154
    CrossrefPubMedGoogle Scholar
  • 24 Donati D, Di Liddo M, Zavatta M , et al. Massive bone allograft reconstruction in high-grade osteosarcoma. Clin Orthop Relat Res 2000; (377) 186-194
    PubMedGoogle Scholar
  • 25 Schuh R, Panotopoulos J, Puchner SE , et al. Vascularised or non-vascularised autologous fibular grafting for the reconstruction of a diaphyseal bone defect after resection of a musculoskeletal tumour. Bone Joint J 2014; 96-B (9) 1258-1263
    CrossrefPubMedGoogle Scholar
  • 26 Shalaby S, Shalaby H, Bassiony A. Limb salvage for osteosarcoma of the distal tibia with resection arthrodesis, autogenous fibular graft and Ilizarov external fixator. J Bone Joint Surg Br 2006; 88 (12) 1642-1646
    CrossrefPubMedGoogle Scholar
  • 27 Asavamongkolkul A, Waikakul S, Phimolsarnti R, Kiatisevi P. Functional outcome following excision of a tumour and reconstruction of the distal radius. Int Orthop 2009; 33 (1) 203-209 (SICOT)
    CrossrefPubMedGoogle Scholar
  • 28 Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 1993; (286) 241-246
    PubMedGoogle Scholar
  • 29 El-Gammal TA, El-Sayed A, Kotb MM. Reconstruction of lower limb bone defects after sarcoma resection in children and adolescents using free vascularized fibular transfer. J Pediatr Orthop B 2003; 12 (4) 233-243
    CrossrefPubMedGoogle Scholar
  • 30 Ihara K, Doi K, Yamamoto M, Kawai S. Free vascularized fibular grafts for large bone defects in the extremities after tumor excision. J Reconstr Microsurg 1998; 14 (6) 371-376
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Rose PS, Shin AY, Bishop AT, Moran SL, Sim FH. Vascularized free fibula transfer for oncologic reconstruction of the humerus. Clin Orthop Relat Res 2005; 438 (438) 80-84
    PubMedGoogle Scholar
  • 32 Moore JR, Weiland AJ, Daniel RK. Use of free vascularized bone grafts in the treatment of bone tumors. Clin Orthop Relat Res 1983; (175) 37-44
    PubMedGoogle Scholar
  • 33 Smeele LE, Hoekstra OS, Winters HAH, Leemans CR. Clinical effectiveness of 99mTc-diphosphonate scintigraphy of revascularized iliac crest flaps. Int J Oral Maxillofac Surg 1996; 25 (5) 366-369
    CrossrefPubMedGoogle Scholar
  • 34 Ryan PJ, Fogelman I. The bone scan: where are we now?. Semin Nucl Med 1995; 25 (2) 76-91
    CrossrefPubMedGoogle Scholar
  • 35 Buyukdereli G, Guney IB, Ozerdem G, Kesiktas E. Evaluation of vascularized graft reconstruction of the mandible with Tc-99m MDP bone scintigraphy. Ann Nucl Med 2006; 20 (2) 89-93
    CrossrefPubMedGoogle Scholar