Outcomes of free vascularized fibular flaps for the treatment of radiation-associated femoral nonunions

Meagan E. Tibbo, Matthew T. Houdek, Karim Bakri, Peter S. Rose, S. Andrew Sems, Steven L. Moran

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Introduction: Nonunion is a known complication following fracture in the setting of radiotherapy. Free vascularized fibular (FVF) flaps have been used successfully in the treatment of segmental bone defects; however, their efficacy in the treatment of radiated nonunions is limited. The purpose of the study was to evaluate the outcome following FVFG for radiation-associated femoral fracture nonunions. Methods: 23 (11 male and 12 female; mean age 60 ± 12 years) patients underwent FVF for radiation-associated femoral fracture nonunions. The most common indication for radiotherapy was soft tissue sarcomas (n = 16). The mean follow-up was 5 ± 4 years. Mean radiation dose was 51 ± 14 Gy at a mean of 11 ± 3 years prior to FVF. The mean FVF length was 17 ± 4 cm and placed commonly with an intramedullary nail (n = 18). Results: First time union was 52% (n = 12) following additional bone grafting, the overall union was 78% (n = 18) at a mean of 13 ± 6 months. Musculoskeletal Tumor Society scores improved from 30% preoperatively to 73% at latest follow-up (p < 0.0001). Five fractures failed to unite; 3 were converted to proximal femoral replacements. Conclusions: FVF are a reasonable treatment option for radiation-associated femoral fracture nonunions, providing a union rate of 78% and an improvement in functional outcome. Level of Evidence: Therapeutic Level IV.

Original languageEnglish (US)
Pages (from-to)1989-1994
Number of pages6
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Issue number11
StatePublished - Nov 2020


  • Femur
  • Nonunion
  • Radiation-associated fracture
  • Union rate
  • Vascularized fibular flap

ASJC Scopus subject areas

  • Surgery


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