Free Fibular Flap for Clavicle Reconstruction: An Orthoplastic Approach

Clavicular reconstruction poses several challenges for reconstructive surgeons, especially when addressing long bone defects. The authors present a European multicenter case series evaluating the use of the free fibula flap for clavicle reconstruction, reporting outcomes in a uniform manner and applying orthoplastic concepts to suggest technical tips for maximizing procedural success.

Adult patients with clavicular bone loss due to trauma, infection, or oncologic resection were included. Surgical outcomes were measured in terms of bone healing and functional recovery using preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand and Constant-Murley scores. Complication rates were recorded. Patients were followed up with radiographs obtained at 1, 3, 6, 9, and 12 months.

Nine patients with a mean age of 44.4 ± 16.4 years were included. The mean clavicular bone defect was 8.5 ± 2.8 cm. Defect etiologies included sarcoma excision ( n = 5), fracture-related infection ( n = 2), osteoradionecrosis ( n = 1), and chronic sclerosing osteomyelitis of Garré ( n = 1). The average follow-up was 32.8 ± 13.1 months. Successful bone union was achieved in all cases after 180 ± 20 days. Significant improvements in Disabilities of the Arm, Shoulder, and Hand and Constant-Murley scores were recorded. Orthoplastic principles were applied, including dual-plate fixation in a 90-degree configuration and the use of minifragment plates.

This study supports the efficacy of the free fibular flap for reconstructing critical-sized clavicular defects and emphasizes technical strategies to achieve stability of the final construct and optimize functional outcomes.