title: The vascularised fibular graft for limb salvage after bone tumour surgery: a multicentre study.
abstract: Vascularised fibular grafts (VFGs ) are a valuable surgical technique in limb salvage after resection of a tumour. The primary objective of this multicentre study was to assess the risk factors for failure and complications for using a VFG after resection of a tumour. The study involved 74 consecutive patients (45 men and 29 women with mean age of 23 years (1 to 64) from four tertiary centres for orthopaedic oncology who underwent reconstruction using a VFG after resection of a tumour between 1996 and 2011. There were 52 primary and 22 secondary reconstructions. The mean follow-up was 77 months (10 to 195). In all, 69 patients (93%) had successful limb salvage; all of these united and 65 (88%) showed hypertrophy of the graft. The mean time to union differed between those involving the upper (28 weeks; 12 to 96) and lower limbs (44 weeks; 12 to 250). Fracture occurred in 11 (15%), and nonunion in 14 (19%) patients. In 35 patients (47%) at least one complication arose, with a greater proportion in lower limb reconstructions, non-bridging osteosynthesis, and in children. These complications resulted in revision surgery in 26 patients (35%). VFG is a successful and durable technique for reconstruction of a defect in bone after resection of a tumour, but is accompanied by a significant risk of complications, that often require revision surgery. Union was not markedly influenced by the need for chemo- or radiotherapy, but should not be expected during chemotherapy. Therefore, restricted weight-bearing within this period is advocated.
authors.affiliation: Leiden University Medical Centre, Albinusdreef 2, 2300RC Leiden, The, Netherlands.
authors.forename: P H
authors.initials: PH
authors.lastname: Hilven
authors.affiliation: Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7HE, UK.
authors.forename: L
authors.initials: L
authors.lastname: Bayliss
authors.affiliation: Academic Medical Centre, Postbus 22660 1100 DD Amsterdam, The, Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Cosker
authors.affiliation: Leiden University Medical Centre, Albinusdreef 2, 2300RC Leiden, The, Netherlands.
authors.forename: P D S
authors.initials: PD
authors.lastname: Dijkstra
authors.affiliation: University Medical Center, Hanzeplein 1 Postbus 30.001 9700 RB Groningen, The, Netherlands.
authors.forename: P C
authors.initials: PC
authors.lastname: Jutte
authors.affiliation: Kantonsspital, St. Gallen, Switzerland.
authors.forename: L U
authors.initials: LU
authors.lastname: Lahoda
authors.affiliation: Academic Medical Centre, Postbus 22660 1100 DD Amsterdam, The, Netherlands.
authors.forename: G R
authors.initials: GR
authors.lastname: Schaap
authors.affiliation: Academic Medical Centre, Postbus 22660 1100 DD Amsterdam, The, Netherlands.
authors.forename: J A M
authors.initials: JA
authors.lastname: Bramer
authors.affiliation: Leiden University Medical Centre, Albinusdreef 2, 2300RC Leiden, The, Netherlands.
authors.forename: G K
authors.initials: GK
authors.lastname: van Drunen
authors.affiliation: Academic Medical Centre, Postbus 22660 1100 DD Amsterdam, The, Netherlands.
authors.forename: S D
authors.initials: SD
authors.lastname: Strackee
authors.affiliation: Leiden University Medical Centre, Albinusdreef 2, 2300RC Leiden, The, Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van Vooren
authors.affiliation: Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7HE, UK.
authors.forename: M
authors.initials: M
authors.lastname: Gibbons
authors.affiliation: Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7HE, UK.
authors.forename: H
authors.initials: H
authors.lastname: Giele
authors.affiliation: Leiden University Medical Centre, Albinusdreef 2, 2300RC Leiden, The, Netherlands.
authors.forename: M A J
authors.initials: MA
authors.lastname: van de Sande
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005360:Fibula / Q000637:transplantation*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000601:surgery*; D019651:Plastic Surgery Procedures; D012512:Sarcoma, Ewing / Q000601:surgery*; D016474:Weight-Bearing; D055815:Young Adult
keywords: bone tumour; reconstruction; vascularised fibular graft