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Free vascularized fibular graft reconstruction of large skeletal defects after tumor resection.

Publication ,  Journal Article
Eward, WC; Kontogeorgakos, V; Levin, LS; Brigman, BE
Published in: Clin Orthop Relat Res
February 2010

UNLABELLED: 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.

Duke Scholars

Published In

Clin Orthop Relat Res

DOI

EISSN

1528-1132

Publication Date

February 2010

Volume

468

Issue

2

Start / End Page

590 / 598

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Transplantation, Autologous
  • Time Factors
  • Surgical Wound Infection
  • Retrospective Studies
  • Reoperation
  • Radiography
  • Osseointegration
  • Orthopedics
 

Citation

APA
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MLA
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Eward, W. C., Kontogeorgakos, V., Levin, L. S., & Brigman, B. E. (2010). Free vascularized fibular graft reconstruction of large skeletal defects after tumor resection. Clin Orthop Relat Res, 468(2), 590–598. https://doi.org/10.1007/s11999-009-1053-x
Eward, William C., Vasileios Kontogeorgakos, Lawrence Scott Levin, and Brian E. Brigman. “Free vascularized fibular graft reconstruction of large skeletal defects after tumor resection.Clin Orthop Relat Res 468, no. 2 (February 2010): 590–98. https://doi.org/10.1007/s11999-009-1053-x.
Eward WC, Kontogeorgakos V, Levin LS, Brigman BE. Free vascularized fibular graft reconstruction of large skeletal defects after tumor resection. Clin Orthop Relat Res. 2010 Feb;468(2):590–8.
Eward, William C., et al. “Free vascularized fibular graft reconstruction of large skeletal defects after tumor resection.Clin Orthop Relat Res, vol. 468, no. 2, Feb. 2010, pp. 590–98. Pubmed, doi:10.1007/s11999-009-1053-x.
Eward WC, Kontogeorgakos V, Levin LS, Brigman BE. Free vascularized fibular graft reconstruction of large skeletal defects after tumor resection. Clin Orthop Relat Res. 2010 Feb;468(2):590–598.
Journal cover image

Published In

Clin Orthop Relat Res

DOI

EISSN

1528-1132

Publication Date

February 2010

Volume

468

Issue

2

Start / End Page

590 / 598

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Transplantation, Autologous
  • Time Factors
  • Surgical Wound Infection
  • Retrospective Studies
  • Reoperation
  • Radiography
  • Osseointegration
  • Orthopedics