Reconstruction of extremity long bone defects after sarcoma resection with vascularized fibula flaps: a 10-year review.
BACKGROUND
Limb-sparing wide excision has become as effective as amputation in treating extremity sarcoma. Limb reconstruction has traditionally involved allografting. The authors evaluated reconstruction of extremity long bone defects after tumor resection using fibula free flaps.


METHODS
A retrospective chart review (1991 to 2002) was performed of 25 consecutive patients at Memorial Sloan-Kettering Cancer Center who underwent reconstruction with free fibula flaps after limb-sparing resection of extremity sarcomas. Timing of reconstruction, complications, metastasis, survival, bone union, and functional outcome were analyzed. Functional assessment was based on the 1987 Musculoskeletal Tumor Society Score/Enneking classification.


RESULTS
Twenty-five patients (14 male patients and 11 female patients) were treated. Osteosarcoma (n = 8), Ewing's sarcoma (n = 8), and chondrosarcoma (n = 6) accounted for the majority of the cases. Reconstructed areas included tibia (n = 9), radius (n = 5), humerus (n = 6), femur (n = 4), and ulna (n = 1). All flaps survived (100 percent). One patient required emergent reexploration (4 percent), one suffered partial flap skin loss (4 percent), and three experienced postoperative infections (12 percent). In patients followed over 6 months, uncomplicated bony union was achieved in 11 of 14 patients (78 percent). After secondary procedures, bony union was ultimately achieved in 13 of 14 patients (93 percent), all of whom had good functional outcomes. Eight patients suffered local recurrences or metastases (32 percent); six died during the study period.


CONCLUSIONS
The microvascular free fibula flap has a lower infection rate than traditional allograft reconstruction. There is a high rate of bone union, and functional outcome is good. Thus, the authors recommend the microvascular fibula transfer as the technique of choice for reconstructing large, complex long bone defects resulting from tumor extirpation.
Chen
Constance M
CM
Plastic and Reconstructive and Orthopedic Services, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Disa
Joseph J
JJ
Lee
Hung-Yi
HY
Mehrara
Babak J
BJ
Hu
Qun-Ying
QY
Nathan
Suresh
S
Boland
Patrick
P
Healey
John
J
Cordeiro
Peter G
PG
D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000601:surgery*; D002648:Child; D005260:Female; D005266:Femoral Neoplasms / Q000601:surgery; D006801:Humans; D006811:Humerus; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D011884:Radius; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012509:Sarcoma / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply; D013977:Tibia; D014457:Ulna