Complications and Long-Term Outcomes of Free Fibula Reconstruction following Resection of a Malignant Tumor in the Extremities

Background: To achieve limb salvage and provide the patient with a functional extremity, vascularized free fibula transfer has become the workhorse for segmental bony reconstruction. Because of various host factors, there has been a high complication rate following oncologic reconstruction. The authors reviewed the experience of their institution with the use of free fibula reconstruction following an oncologic resection in the extremities. Methods: The authors reviewed 56 cases of free fibula transfer performed for limb salvage following oncologic resection from 1994 through 2013. The cohort consisted of 30 male patients and 26 female patients; with a mean age of 19 years and a mean follow-up of 7 years. Sixty-three percent of the tumors were located in the lower extremity. Results: The overall 2-, 5-, 10-, and 15-year survival rates were 98, 86, 73, and 73 percent, respectively. With regard to disease-specific survival, the overall 2-, 5-, 10, and 15-year survival rates were 82, 75, 67, and 50 percent, respectively. Seventy-five percent of cases healed primarily, with a mean time to union of 10 months. The overall union rate was 98 percent following supplemental bone grafting. Chemotherapy following the free fibula graft increased the risk (hazard ratio, 2.10; p = 0.03) of a delayed union. The overall rate of limb salvage was 93 percent, with four patients requiring an amputation. Conclusions: The free fibula is considered the workhorse vascularized bone graft for extremity reconstruction in limb salvage surgery. In the oncologic setting, a repeated bone grafting procedure was common, and should be expected in patients undergoing chemotherapy. Limb salvage rates are high with this technique. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.