Clinical usage of vascularized free fibular transplant combining with massive bone allografts for repair large bone or osteoarticular defects secondary to bone tumors resection

Objective To report the effect of clinical usage of vascularized free fibular transplant combining with massive bone allografts for repairing large bone or osteoarticular defects after bone tumors resection. Methods From January 2001 to December 2002, Massive bone or osteoarticular defects secondary to bone tumors resection in ten patients (six men and four women,age range 9 to 27 years) were repaired by vascularized free fibular transplant with a monitoring-flap combining with massive deep frozen bone allografts.The length of bone defects range from 12 to 25cm,mean:15cm.Particularly,one's shoulder joint was reconstructed by transplanting the proximal fibula combining with the proximal humerus allograft after resecting his proximal humerus.In this group,four patients suffered from malignant fibrous histiocytomain proximal humerus,osteosarcoma in proximal humerus giant cell tumor in distal femur and fibrous dysplasis in shaft of tibia respectively,the remainder six patients suffered from osteosarcoma in femural shaft.MRI (magnetic resonance imaging) was used to detect where the lesion was before surgery and neodjuvant chemotherapy was also used in all malignant bone tumor patients preoperative and postoperative. Results Only two patients had slight immune reaction of yellowish effusion postoperatively,which disappeared in two to three weeks by local management.All the ten patients were followed up from five to twenty-four months.Eight patients had the evidence of radiographic union three months after surgery.Five patients had clinic bone union and began to act freely one year postoperative after removing internal fixation. Conclusion Combining with massive deep frozen bone allografts,vascularized free fibular transplant with a monitoring-flap can be clinically used as an effective and reliable method for repairing massive bone or osteoarticular defects after bone tumors resection.