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.
Level of Evidence: Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution approved the human protocol for this investigation and waived informed consent
for participation in the study and all investigations were conducted in conformity with ethical principles of research.
This work was performed at Duke University Medical Center.