Extremity reconstruction using a free fibula flap after oncological resection Reconstrução de extremidades com retalho livre de fíbula após ressecções oncológicas

Background: Primary tumors of the long bones are rare, accounting for 0.2–1% of malignant tumors. In the past, amputation was the standard treatment and had a large impact on patient morbidity and mortality. With advances in surgical techniques and multidisciplinary involvement, conservative surgery of the limbs has become the treatment of choice, and reconstruction using a microsurgical fibula flap is the most commonly used technique. In this study, we aimed to present the experience of the National Cancer Institute (INCA) with limb reconstruction using a microsurgical fibula flap following tumor resection from the long bones. Methods: We retrospectively analyzed 7 cases of free fibular flap surgery at the INCA from 1997 to 2009 for the reconstruction of defects of the extremities after bone tumor resection. We evaluated the following parameters: gender, age, diagnosis, tumor location, resection size and type, reconstruction size and type, vessels used for the anastomosis, postoperative complications, disease status at the last visit, follow-up, and time to ambulation. Results: Seven patients with a mean age of 11.8 years (range, 5–14 years) underwent extremity reconstruction with a free fibula flap with 100% bone viability. The lesions were located within the femur, tibia, or humerus. Osteosarcoma was the most common tumor type. The average return to ambulation was 14.7 months. Conclusions: The use of a free fibula flap is an excellent alternative for limb reconstruction and features a high bone healing rate, early ambulation, good functionality, and a low complication rate.