Application of fibula transplantation in the reconstruction of bone defects after bone tumor resection
SANG Shang
DONG Yang
ZHANG Zhi-chang
JI Wei-ping
YANG Qing-cheng
Abstract：Objective To explore the application of fibula transplantation in the reconstruction of bone defects caused by the operation of bone tumor resection. Methods We reviewed the patients who were treated by fibula transplantation for bone tumors in our clinical center from 2010 to 2015. There were 57 cases in all, including 22 male cases and 35 female cases. The patients’ age ranged from 3 to 62 years old. There were 24 cases of osteosarcoma, 14 cases of giant cell tumor of bone, 4 cases of bone metastasis of malignant tumor, 3 cases of Ewing’s sarcoma, 3 cases of fibrous dysplasia, 3 cases of chondrosarcoma, 3 cases of aneurysmal bone cyst, 1 case of bone cyst, 1 case of malignant fibrous histiocytoma, and 1 case of capillary hemangioma. Thirty-seven cases received vascular pedicled fibula graft, and 20 cases received fibula transplantation without vascular pedicles. These patients were followed up from 4 months to 5 years after the operation. In the group who received vascular pedicled fibula graft, the length of the graft was 5 - 22 cm and the average length was 14.24 cm; the operation time ranged from 2.5 h to 8 h and the average time was 320 min; the intraoperative bleeding ranged from 100 ml to 2300 ml and the average bleeding was 483.78 ml. In the group who received fibula transplantation without vascular pedicles, the length of fibula graft ranged from 4 cm to 15 cm and the average length was 8.78 cm; the operation time ranged from 80 min to 7 h and the average time was 180 min; the intraoperative bleeding ranged from 100 ml to 1500 ml and the average bleeding was 340 ml. Results In the group who received vascular pedicled fibula graft, the patients were followed up from 7 months to 5 years after the operation and the average time was 29.5 months. There were 6 cases of postoperative bone nonunion, 3 cases of postoperative tumor recurrence and 1 case of death in this group and the rest 27 patients got satisfied recovery without recurrence. In the group who received fibula transplantation without vascular pedicles, the patients were followed up from 8 months to 5 years, and the average time was 30 months. There were 3 cases of postoperative bone nonunion, 1 case of postoperative tumor recurrence and 2 cases of death in this group and the rest 14 patients got satisfied recovery without recurrence. Conclusions ( 1 ) Fibula transplantation is a reliable technique for long bone defect reconstruction. ( 2 ) Fibula transplantation with or without vascular pedicles depends on the length of the fibula graft. It’s suggested that vascular pedicled fibula transplantation should be chosen when the bone defect is more than 7 cm. ( 3 ) The length of the fibula graft, the muscle sleeve of the fibula, the blood supply of the donor site and the technique of the vascular anastomosis directly affect the operation results. ( 4 ) Adult femoral and tibial defects should be treated with composite fibula. ( 5 ) The inferior tibiofibular joint fusion should be performed in cases of the ankle joint instability. ( 6 ) We need to have a good communication with the patients because the healing time could be quite long after the operation.
Keywords：FibulaBone transplantationBone neoplasmsBone remodelingMicrosurgery
Publication Date：2017-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 96-100 )