Microsurgical reconstruction of lower limb bone defects following tumor resection using vascularized fibula osteoseptocutaneous flap

This study included 25 patients with lower limb tumors who had wide local resection and reconstruction by vascularized fibula osteoseptocutaneous flap, and who had their surgery performed at least 24 months before the end of the study. The average age at operation was 23.5 years. Twenty-three tumors were malignant;16 were staged as high-grade sarcomas (stage IIA, stage IIB, and Ewing's sarcoma). Tumor volume averaged 293.2 cc (range, 41.4-860). The resulting defect after tumor resection averaged 16 cm (range, 9-20 cm). The fibula was inserted as a single strut in 21 patients, and as a double-barrel construct in 4 patients. Fixation was augmented by interlocking nail in 11 cases, bridge plate in 9 cases, and external fixator in 5 cases. Twenty-four (96%) flaps survived. All grafts united in an average period of 4.5 months (range, 3-8 months) after transfer. Two secondary procedures were necessary to achieve graft union. Full weight bearing was possible after an average period of 7.5 months (range, 5-14 months). Significant hypertrophy (greater than or equal to30% of original fibular diameter) occurred in 85% of patients after an average period of 10 months from the index operation. In the latest follow-up radiographs (mean, 32 months), the degree of hypertrophy averaged 90% (range, 30-200%). Graft fracture occurred in three patients, and all healed conservatively. The Musculoskeletal Tumor Society rating score (MTSRS) averaged 21.2 points at the end of the first postoperative year, and 23.6 at the end of the study. (C) 2002 Wiley Liss, Inc.