Effectiveness of free vascularized fibular graft for bone defect after resection of lower limb malignant tumor_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TAN Lei ¹ ,  XING Zhili ¹ , JI Tao ² , GUO Wei ²

1. Department of Orthopedics, Peking University International Hospital, Beijing, 102206, P.R.China;
2. Department of Musculoskeletal Tumor, Peking University People’s Hospital, Beijing, 100044, P.R.China;

Corresponding?author：

XING Zhili, Email: XINGZHILI@pkuih.edu.cn

Keywords：

Free vascularized fibula; bone graft; bone tumor; bone defect; repair; lower limb

DOI：

10.7507/1002-1892.201810118

Video：

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Objective To analyze the effectiveness of free vascularized fibula grafts (FVFG) for extensive bone defects after resection of lower limb malignant bone tumors. Methods Between November 2015 and July 2018, 15 cases of lower limb malignant bone tumors were treated. There were 12 males and 3 females with an average age of 12.3 years (range, 9-21 years). There were 11 cases of osteosarcoma and 4 cases of Ewing’s sarcoma. The tumor located at middle femur in 8 cases, lower femur in 4 cases, and middle tibia in 3 cases. The disease duration was 2-6 months (mean, 3.2 months). The tumor was completely removed, and the length of the bone defect was 8-23 cm (mean, 17.7 cm). The bone defect was repaired by FVFG, and combined inactivated tumor bone was used in 8 cases of femoral bone defect. Results The average operation time was 280 minutes (range, 180-390 minutes). The average blood loss was 310 mL (range, 200-480 mL). All incisions healed by first intention. All patients were followed up 2-24 months with an average of 14.5 months. Bone healing achieved in all patients at 9-18 months (mean, 12.3 months) after operation except 1 patient which was followed up only 2 months. The fibula grafts had active metabolism and the average bone metabolism score was 184 (range, 111-257) in effected side and 193 (range, 127-259) in contralateral side. There was no difference between bilateral sides. The average Enneking score was 24.6 (range, 20-30) at last follow-up. No ankle instability or paralysis of common peroneal nerve occurred. Conclusion FVFG appeared very efficient in repair of extensive bone defect after resection of lower limb malignant bone tumor.

Citation： TAN Lei, XING Zhili, JI Tao, GUO Wei. Effectiveness of free vascularized fibular graft for bone defect after resection of lower limb malignant tumor. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(7): 850-853. doi: 10.7507/1002-1892.201810118 Copy

1.	Carty CP, Dickinson IC, Watts MC, et al. Impairment and disability following limb salvage procedures for bone sarcoma. Knee, 2009, 16(5): 405-408.
2.	Ruggieri P, Mavrogenis AF, Mercuri M. Quality of life following limb-salvage surgery for bone sarcomas. Expert Rev Pharmacoecon Outcomes Res, 2011, 11(1): 59-73.
3.	Venkatramani H, Sabapathy SR, Dheenadayalan J, et al. Reconstruction of post-traumatic long segment bone defects of the lower end of the femur by free vascularized fibula combined with allograft (modified Capanna's technique). Eur J Trauma Emerg Surg, 2015, 41(1): 17-24.
4.	Noaman HH. Management of upper limb bone defects using free vascularized osteoseptocutaneous fibular bone graft. Ann Plast Surg, 2013, 71(5): 503-509.
5.	Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
6.	Panagopoulos GN, Mavrogenis AF, Mauffrey C, et al. Intercalary reconstructions after bone tumor resections: a review of treatments. Eur J Orthop Surg Traumatol, 2017, 27(6): 737-746.
7.	Taylor GI, Miller GD, Hem FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg, 1975, 55(5): 533-544.
8.	李遠輝, 楊運發, 胡漢生, 等. 帶血管腓骨移植修復四肢大段骨缺損: 可有效促進骨愈合. 中國組織工程研究, 2015, 19(11): 1641-1646.
9.	Tanaka K, Maehara H, Kanaya F. Vascularized fibular graft for bone defects after wide resection of musculoskeletal tumors. J Orthop Sci, 2012, 17(2): 156-162.
10.	Yajima H, Tamai S, Mizumoto S, et al. Vascularized fibular grafts for reconstruction of the femur. J Bone Joint Surg (Br), 1993, 75(1): 123-128.
11.	Usui M. Free vascularized fibular grafting for reconstruction after tumor resection. Rinshou Seikeigeka, 1998, 33(3): 267-276.
12.	Shimose S, Sugita T, Ishida O, et al. Reconstruction using vascularized fibular grafts in malignant bone and soft tissue tumors. Kansetu Geka, 2005, 24: 846-850.
13.	Pederson WC, Person DW. Long bone reconstruction with vascularized bone grafts. Orthop Clin North Am, 2007, 38(1): 23-35.
14.	鄭戰營, 劉紅偉, 李干卿, 等. 外固定架加腓骨移植治療骨腫瘤及病理性骨折. 實用骨科雜志, 2008, 14(4): 238-240.
15.	左之良, 劉向春, 穆國斌, 等. 自體腓骨移植治療股骨下1/3骨折伴大段缺損. 中國骨傷, 2010, 23(1): 62-63.
16.	Rose PS, Shin AY, Bishop AT, et al. Vascularized free fibula transfer for oncologic reconstruction of the humerus. Clin Orthop Relat Res, 2005, (438): 80-84.
17.	Zaretski A, Amir A, Meller I, et al. Free fibula long bone reconstruction in orthopedic oncology: a surgical algorithm for reconstructive options. Plast Reconstr Surg, 2004, 113(7): 1989-2000.
18.	Eward WC, Kontogeorgakos V, Levin LS, et al. Free vascularized fibular graft reconstruction of large skeletal defects after tumor resection. Clin Orthop Relat Res, 2010, 468(2): 590-598.
19.	Mankin HJ, Gebhardt MC, Jennings LC, et al. Long-term results of allograft replacement in the management of bone tumors. Clin Orthop Relat Res, 1996, (324): 86-97.
20.	Brigman BE, Hornicek FJ, Gebhardt MC, et al. Allografts about the knee in young patients with high-grade sarcoma. Clin Orthop Relat Res, 2004, (421): 232-239.
21.	Guo QF, Xu ZH, Wen SF, et al. Value of a skin island flap as a postoperative predictor of vascularized fibula graft viability in extensive diaphyseal bone defect reconstruction. Orthop Traumatol Surg Res, 2012, 98(5): 576-582.
22.	Ghert M, Colterjohn N, Manfrini M, et al. The use of free vascularized fibular grafts in skeletal reconstruction for bone tumors in children. J Am Acad Orthop Surg, 2007, 15(10): 577-587.
23.	Malizos KN, Zalavras CG, Soucacos PN, et al. Free vascularized fibular grafts for reconstruction of skeletal defects. J Am Acad Orthop Surg, 2004, 12(5): 360-369.
24.	劉亞平, 程國良, 潘達德, 等. 帶血管腓骨移植的遠期療效報告. 中華骨科雜志, 2001, 21(1): 22-26.
25.	Jager T, Journeau P, Dautel G, et al. Is combining massive bone allograft with free vascularized fibular flap the children’s reconstruction answer to lower limb defects following bone tumour resection? Orthop Traumatol Surg Res, 2010, 96(4): 340-347.

1. Carty CP, Dickinson IC, Watts MC, et al. Impairment and disability following limb salvage procedures for bone sarcoma. Knee, 2009, 16(5): 405-408.
2. Ruggieri P, Mavrogenis AF, Mercuri M. Quality of life following limb-salvage surgery for bone sarcomas. Expert Rev Pharmacoecon Outcomes Res, 2011, 11(1): 59-73.
3. Venkatramani H, Sabapathy SR, Dheenadayalan J, et al. Reconstruction of post-traumatic long segment bone defects of the lower end of the femur by free vascularized fibula combined with allograft (modified Capanna's technique). Eur J Trauma Emerg Surg, 2015, 41(1): 17-24.
4. Noaman HH. Management of upper limb bone defects using free vascularized osteoseptocutaneous fibular bone graft. Ann Plast Surg, 2013, 71(5): 503-509.
5. Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
6. Panagopoulos GN, Mavrogenis AF, Mauffrey C, et al. Intercalary reconstructions after bone tumor resections: a review of treatments. Eur J Orthop Surg Traumatol, 2017, 27(6): 737-746.
7. Taylor GI, Miller GD, Hem FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg, 1975, 55(5): 533-544.
8. 李遠輝, 楊運發, 胡漢生, 等. 帶血管腓骨移植修復四肢大段骨缺損: 可有效促進骨愈合. 中國組織工程研究, 2015, 19(11): 1641-1646.
9. Tanaka K, Maehara H, Kanaya F. Vascularized fibular graft for bone defects after wide resection of musculoskeletal tumors. J Orthop Sci, 2012, 17(2): 156-162.
10. Yajima H, Tamai S, Mizumoto S, et al. Vascularized fibular grafts for reconstruction of the femur. J Bone Joint Surg (Br), 1993, 75(1): 123-128.
11. Usui M. Free vascularized fibular grafting for reconstruction after tumor resection. Rinshou Seikeigeka, 1998, 33(3): 267-276.
12. Shimose S, Sugita T, Ishida O, et al. Reconstruction using vascularized fibular grafts in malignant bone and soft tissue tumors. Kansetu Geka, 2005, 24: 846-850.
13. Pederson WC, Person DW. Long bone reconstruction with vascularized bone grafts. Orthop Clin North Am, 2007, 38(1): 23-35.
14. 鄭戰營, 劉紅偉, 李干卿, 等. 外固定架加腓骨移植治療骨腫瘤及病理性骨折. 實用骨科雜志, 2008, 14(4): 238-240.
15. 左之良, 劉向春, 穆國斌, 等. 自體腓骨移植治療股骨下1/3骨折伴大段缺損. 中國骨傷, 2010, 23(1): 62-63.
16. Rose PS, Shin AY, Bishop AT, et al. Vascularized free fibula transfer for oncologic reconstruction of the humerus. Clin Orthop Relat Res, 2005, (438): 80-84.
17. Zaretski A, Amir A, Meller I, et al. Free fibula long bone reconstruction in orthopedic oncology: a surgical algorithm for reconstructive options. Plast Reconstr Surg, 2004, 113(7): 1989-2000.
18. Eward WC, Kontogeorgakos V, Levin LS, et al. Free vascularized fibular graft reconstruction of large skeletal defects after tumor resection. Clin Orthop Relat Res, 2010, 468(2): 590-598.
19. Mankin HJ, Gebhardt MC, Jennings LC, et al. Long-term results of allograft replacement in the management of bone tumors. Clin Orthop Relat Res, 1996, (324): 86-97.
20. Brigman BE, Hornicek FJ, Gebhardt MC, et al. Allografts about the knee in young patients with high-grade sarcoma. Clin Orthop Relat Res, 2004, (421): 232-239.
21. Guo QF, Xu ZH, Wen SF, et al. Value of a skin island flap as a postoperative predictor of vascularized fibula graft viability in extensive diaphyseal bone defect reconstruction. Orthop Traumatol Surg Res, 2012, 98(5): 576-582.
22. Ghert M, Colterjohn N, Manfrini M, et al. The use of free vascularized fibular grafts in skeletal reconstruction for bone tumors in children. J Am Acad Orthop Surg, 2007, 15(10): 577-587.
23. Malizos KN, Zalavras CG, Soucacos PN, et al. Free vascularized fibular grafts for reconstruction of skeletal defects. J Am Acad Orthop Surg, 2004, 12(5): 360-369.
24. 劉亞平, 程國良, 潘達德, 等. 帶血管腓骨移植的遠期療效報告. 中華骨科雜志, 2001, 21(1): 22-26.
25. Jager T, Journeau P, Dautel G, et al. Is combining massive bone allograft with free vascularized fibular flap the children’s reconstruction answer to lower limb defects following bone tumour resection? Orthop Traumatol Surg Res, 2010, 96(4): 340-347.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of free vascularized fibular graft for bone defect after resection of lower limb malignant tumor

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