Pedicled vascularized fibular graft with Ilizarov external fixator for reconstructing a large bone defect of the tibia after tumor resection

Abstract

BACKGROUND: Large bony defects in the middle or distal third of the tibia resulting from surgical resection of malignant bone tumors present a difficult reconstructive challenge. Various methods of reconstruction are available, such as allografts, vascularized fibular graft (either free or pedicled), or endoprothesis replacement for distal defects. MATERIALS AND METHODS: Twelve patients--eight males and four females with mean age of 18 years at operation (range 14-25 years)--with malignant bone tumors of the tibial shaft were selected as candidates for wide resection of the tumor and reconstruction of the bony defect by ipsilateral vascularized fibular graft based on the peroneal vessels. Preoperative staging studies, including plain radiography, local MRI, isotopic bone scan, and chest CT, were done for every patient before biopsy. Ilizarov external fixation was then applied in all cases. The average length of the bony gap bridged was 14.5 cm (13-16.5 cm) and the mean length of the harvested graft was 16.3 cm (15-18 cm). The average operation time was 7.5 h (5.5-9.5 h). RESULTS: The mean follow-up period was 38 months (range 32-52 months). Bony union at the proximal and distal ends of the fibula occurred in nine patients (75 %) and at a mean time of 5.5 months (range 4.5-8 months). Graft hypertrophy occurred in all patients. The mean percentage of hypertrophy was 95 % (range 80-160 %). The mean MSTS functional score was 84 % (range 80-92 %). A leg length discrepancy of 2 cm was reported in two patients and was managed using a shoe lift. CONCLUSION: Reconstruction of bony defects of the middle or distal tibia after bone tumor resection using pedicled vascularized fibula is a useful limb salvage procedure. The procedure can be performed relatively quickly and inexpensively and has a low rate of late complications. It leads to a good outcome regarding the union, hypertrophy, and function.