title: The role of the fibula head flap for joint reconstruction after osteoarticular resections.
abstract: OBJECTIVE
  Endoprosthetic reconstruction is considered the mainstay of limb salvage in periarticular bone tumours. However, this procedure has limited durability especially when performed in young patients. The free fibula head flap including the proximal articular surface represents one option for hemiarthroplasty reconstruction. The aim of this study was to investigate the role of the fibula head flap for joint reconstruction after osteoarticular resections.
  
  
  METHODS
  All patients who underwent hemiarthroplasty procedures between 2000 and 2006 using the free fibula head flap were included in the study. Functional assessments were performed using the American Musculoskeletal Tumor Society (AMTS) classification.
  
  
  RESULTS
  There were five males and two females (mean age: 22.6 ± 15.9 years). Five patients underwent reconstruction following resection of malignant bone tumours and two for chronic osteomyelitis of the distal humerus. In three patients, the fibula was used for distal radius and wrist joint reconstruction, and the remaining four patients for reconstruction of the distal humerus and elbow joint. A vascularised growth plate transfer based on the lateral geniculate vessels was performed in two patients. Atechnetium-bone scan confirmed viability of all flaps 10 days after surgery, and radiographic bony union was confirmed on average 5 months following surgery. There were no complications with the recipient or donor site after a median follow-up of 71 months (range: 12 months to 10 years). All patients achieved reasonable return of function and were able to perform all activities of daily living.
  
  
  CONCLUSIONS
  We demonstrate that the hemiarthroplasty procedure using the free fibula flap with its proximal head is a safe procedure with good functional results. Performing autologous arthroplasty using a free fibula head flap may be a promising alternative to an endoprosthesis or alloplastic reconstruction with a low risk of complications and morbidity.
authors: The Department of Plastic Surgery, The Tel-Aviv Sourasky Medical Center, The Tel-Aviv University, Tel-Aviv, Israel. Electronic address: Mario.scaglioni@gmail.com.
authors: M F
authors: MF
authors: Scaglioni
authors: The Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX, USA.
authors: E I
authors: EI
authors: Chang
authors: The Department of Plastic Surgery, The Tel-Aviv Sourasky Medical Center, The Tel-Aviv University, Tel-Aviv, Israel.
authors: E
authors: E
authors: Gur
authors: The Department of Plastic Surgery, The Tel-Aviv Sourasky Medical Center, The Tel-Aviv University, Tel-Aviv, Israel.
authors: Y
authors: Y
authors: Barnea
authors: The National Unit of Orthopedic Oncology, The Tel-Aviv Sourasky Medical Center, The Tel-Aviv University, Tel-Aviv, Israel.
authors: I
authors: I
authors: Meller
authors: The National Unit of Orthopedic Oncology, The Tel-Aviv Sourasky Medical Center, The Tel-Aviv University, Tel-Aviv, Israel.
authors: Y
authors: Y
authors: Kollander
authors: The National Unit of Orthopedic Oncology, The Tel-Aviv Sourasky Medical Center, The Tel-Aviv University, Tel-Aviv, Israel.
authors: J
authors: J
authors: Bickels
authors: The National Unit of Orthopedic Oncology, The Tel-Aviv Sourasky Medical Center, The Tel-Aviv University, Tel-Aviv, Israel.
authors: S
authors: S
authors: Dadia
authors: The Department of Plastic Surgery, The Tel-Aviv Sourasky Medical Center, The Tel-Aviv University, Tel-Aviv, Israel.
authors: A
authors: A
authors: Zaretski
mesh_terms: D000293:Adolescent; D000328:Adult; D001178:Arthroplasty / Q000379:methods*; D001859:Bone Neoplasms / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D005360:Fibula / Q000637:transplantation*; D058752:Free Tissue Flaps; D018212:Giant Cell Tumor of Bone / Q000601:surgery; D006801:Humans; D006811:Humerus; D008297:Male; D010019:Osteomyelitis / Q000601:surgery*; D012516:Osteosarcoma / Q000601:surgery; D011884:Radius; D012512:Sarcoma, Ewing / Q000601:surgery; D014955:Wrist Joint / Q000601:surgery*
keywords: Free fibula head flap; Vascularised arthroplasty