New technique of reconstruction after resection of tumors of the distal femur : role of inverted pedicled fibular graft

Abstract EN

Background and purpose : the fibular bone has been widely used as a free vascularized graft in reconstruction of defects of the femur after bone tumor resection which is technically demanding and time consuming.

In this study, we describe a technique of rotating the ipsilateral fibula 180˚ on its vascular pedicle to reconstruct lower femur defects after tumour resection aiming at avoiding the morbidity of micro vascular anastomoses.

Patients and methods : A prospective non-randomized study on seven patients (mean age 16.8 years) with estrogenic sarcoma of the lower femur was conducted at the NCI, Cairo University between January 2000 and January 2003.

Those patients underwent preoperative chemotherapy regimens followed by radical resection and reconstruction of the resulting defect with pedicles vas-solarized fibular graft based on the personnel artery.

Internal fixation of the recipient bones was done by broad plate and screws.

Staging and resect ability were determined by preoperative CT chest, bone scan and MRI of the region around the tumor.

Patients with pathological fractures or neurovascular bundle involvement were excluded.

Six patients were stage II B and one patient was stage II A.

Those patients were followed up for a period ranging from 15 to 33 months with an average of 24.2 months.

Results : most resections were wide (six patients), while one was marginal.

The size of the defect ranged from 13 to 23 cm in length (average 16.5 cm).

Radiological evidence of union was noted at an average of 4.2 months (range four to six months).

One patient had nonunion at the proximal junction and required conventional bone grafting.

Hypertrophy of the fibula was seen in two patients.

The functional results were satisfactory (good in five patients, fair in one and poor in one).

Postoperative complications included minor wound infection in one patient, lateral popliteal nerve palsy in two patients, one of whom recovered completely and local recurrence followed by lung metastasis in one patient.

Conclusion : pedicled inverted fibular graft is a valuable reconstruction option after resection of tumors of the lower femur.