Free vascularized fibular grafts for large bone defects in the extremities after tumor excision

Free vascularized fibular grafts were used in nine selected patients with bone tumors in the involved extremity. There were five locally aggressive tumors and four malignant tumors. Each skeletal defect was longer than 10 cm, and the mean length was 13 cm. Ten grafts of 17.4 cm in mean length were harvested in these nine patients. In two cases with upper-extremity involvement, arthroplasty using the fibular head was the procedure of choice, while interacalary grafting was performed in the lower extremity. Dual grafting was performed for complete defects of the femur. The viability of each graft was demonstrated through survival of the combined skin flaps or with a positive bone scan. Primary bony union was obtained in all cases, and the mean time to union was 5.2 months. In the lower extremity, significant hypertrophy of the graft was seen. Satisfactory functional results were obtained in all the patients.