Clinical Results of Reconstruction with an Osteocutaneous Free Fibula Flap, Combined with a Recycled Autogeneous Bone Graft for Bone and Soft Tissue Sarcoma of the Lower Extremities

Abstract

The optimal reconstruction procedure after wide resection of sarcoma in lower extremities, remains controversial. We reviewed the outcomes of 8 recycled intercalary autogenous bone grafts combined with an osteocutaneous free fibula flap for bone and soft tissue sarcoma in the lower extremities. There were five males and three females, between 11 and 49 years of age who were followed up for at least 14 months (average, 38 months). The recycled bone graft was treated by liquid nitrogen in three cases, and by pasteurization procedure in five cases. Bony union was seen in seven patients (88%) an average of 11 months after the operation. In the remaining patient, bone union was not achieved due to infection. Postoperative complications included deep infection and two fractures. There were two local recurrences of sarcomas. The Musculoskeletal Tumor Society score was 70% on average in 4 patients without complications. Our results suggest a recycled autogenous bone graft combined with an osteocutaneous free fibula flap could be a useful reconstruction method in selected patients with large bone defects after wide resection of sarcoma in the lower extremities. Using reliable internal fixation (e.g. a locking plate system) could improve the clinical results and reduce the incidence of fracture of the grafted bone.