title: Free vascularized fibular graft reconstruction of large skeletal defects after tumor resection.
abstract: Skeletal reconstruction of large tumor resection defects is challenging. Free vascularized fibular transfer offers the potential for rapid autograft incorporation in limbs compromised by adjuvant chemotherapy or radiation. We retrospectively reviewed 30 patients treated with free vascularized fibular graft reconstruction of large skeletal defects after tumor resections (mean defect length, 14.8 cm). The minimum followup was 2 years (mean, 4.9 years; range, 2-15 years). One patient died with liver and lung metastases at 3 years postoperatively. Loss of limb occurred in one patient. Five patients either had metastatic disease (one patient) or had metastatic disease (four patients) develop after treatment, with a mean time to metastasis of 18 months. The overall complication rate was 16 of 30 (53%), with a reoperation rate of 12 of 30 (40%). Union was attained in all 30 grafts. Primary union was attained in 23 (77%) at a mean of 6 months. Secondary union was achieved in seven (23%) after revision fixation and bone grafting; the mean subsequent time to union was 9.2 months, with an index of 1.33 additional operations per patient. Graft fracture (20%) and infection (10%) were other common complications. Despite a high complication rate, free vascularized fibular graft reconstruction offers a reliable treatment of large skeletal defects after tumor resection without increased risk of limb loss, local recurrence, or tumor metastasis.
  
  
  METHODS
  Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, Duke University Medical Center, Orange Zone, Box 3000, Durham, NC 27710, USA. w.eward@alumni.duke.edu
authors.forename: William C
authors.initials: WC
authors.lastname: Eward
authors.forename: Vasileios
authors.initials: V
authors.lastname: Kontogeorgakos
authors.forename: Lawrence Scott
authors.initials: LS
authors.lastname: Levin
authors.forename: Brian E
authors.initials: BE
authors.lastname: Brigman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D016025:Bone Transplantation / Q000009:adverse effects; D002648:Child; D005260:Female; D005360:Fibula / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000637:transplantation*; D050723:Fractures, Bone / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016348:Osseointegration; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
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