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Free Vascularized Fibular Graft Salvage of Complications of Long-Bone Allograft After Tumor Reconstruction
Jeffrey B. Friedrich, MD1; Steven L. Moran, MD1; Allen T. Bishop, MD1; Christina M. Wood, MS1; Alexander Y. Shin, MD1
1 Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery (J.B.F., S.L.M., A.T.B., and A.Y.S.) and the Division of Biostatistics, Department of Health Sciences Research (C.M.W.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Jan 01;90(1):93-100. doi: 10.2106/JBJS.G.00551
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Background: Long-bone allograft reconstruction following tumor extirpation can be complicated by problems such as nonunion at the host-allograft junction, allograft fracture, or allograft infection. Free vascularized bone grafts can be used to address these complications. The purpose of the current study was to examine retrospectively the outcomes and complications following allograft reconstruction salvage with onlay vascularized fibular grafts.

Methods: A tumor registry review was conducted to identify all patients who underwent a reconstruction with a vascularized fibular graft for allograft reconstruction complications following tumor resection (host-graft nonunion, allograft fracture, or allograft nonunion) in the last nineteen years. The records of these patients were analyzed for details regarding the neoplasms and the treatment thereof, details of the free vascularized fibular graft reconstruction, time to osseous union, functional outcome, and clinical outcome.

Results: Thirty-three patients satisfied the criteria for this study. The involved bones were the femur (eighteen patients), tibia (eight), and humerus (seven). Osseous union was achieved in all patients at a mean of 7.7 months. The average duration of follow-up was seventy-three months. Twenty-three patients achieved a good or excellent functional outcome. Ultimately, seven patients had a failure of the allograft reconstruction, which resulted in limb loss in five of them. Postoperative complications were relatively common in this series.

Conclusions: Free vascularized fibular grafting is a useful adjunctive surgical treatment for nonunion, fracture, and infection of an intercalary allograft reconstruction in limb salvage surgery. It has, however, a high rate of associated complications often resulting in failure.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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