[Free microvascular fibula graft for skeletal reconstruction after tumor resections in the forearm -- experience with five cases].

Klinik für Hand-, Plastische und Rekonstruktive Chirurgie-Schwerbrandverletztenzentrum, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Plastische und Handchirurgie der Universität Heidelberg.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie (Impact Factor: 0.54). 11/2004; 36(5):301-7.
Source: PubMed

ABSTRACT Plastic-reconstructive surgery for upper extremity tumors not only follows the fundamental principles of oncologic surgery, but also requires attention to functional and aesthetic aspects. For soft tissue reconstruction, a variety of surgical options are available, whereas for the reconstruction of extensive bony defects only the free microvascular fibular transplant appears to be a reasonable method. Its advantages are its slim shape and variable length, the possibility of achieving a stable osteosynthesis suitable for early physiotherapy, and low donor site morbidity, even if the fibula is harvested as an osteoseptocutaneous flap. Between 1994 and 2000, five patients underwent a free fibula transplantation for radius reconstruction. In all cases, a two-stage reconstructive approach with initial tumor biopsy was chosen. The resected tumors were two osteosarcomas, one extraosseous Ewing sarcoma, one aneurysmatic bone cyst and one desmoplastic fibroma. Surgical and pathohistological tumor-free margins were achieved in all cases (R(0)). Two patients received an osteocutaneous graft. All grafts were revascularized to the radial artery and subcutaneous veins. The transplanted fibula grafts were between 10 cm and 17 cm in length. All proximal osteosyntheses were performed fibuloradially, the distal stabilizations were fibulo-scapho-lunate (2 x) and fibulo-radial (3 x), depending on the extent of resection. All microvascular transplants survived completely and showed a stable osseous integration, both clinically and radiologically. Depending on the postoperative course, an adapted intensive physiotherapy regimen yielded good or satisfactory function. In the follow-up of up to seven years in one case a tumor recurrence (osteosarcoma, 35 months post-operatively) required forearm amputation. The reconstruction of tumor-associated wide bony defects in the upper extremity with a free microvascular fibula graft allows for a successful therapy with respect to oncologic, functional and aesthetic considerations.

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    ABSTRACT: INTRODUCTION: The aim of this study was to investigate the intraoperative findings, postoperative complications, donor site morbidity and patients' Quality of Life in order to evaluate the usefulness of the free osteofasciocutaneous fibula flap in the reconstruction or construction of a mandibula, neophallus, lower leg or forearm. MATERIALS AND METHODS: 104 patients were treated with free osteofasciocutaneous fibula flaps in our clinic. 23 for mandible reconstruction, 66 for neophallus reconstruction, 9 for lower leg reconstruction and 6 for forearm reconstruction. These patients were asked to answer a questionnaire and to be present for a clinical and a radiological examination in our department. In addition, their previous records were evaluated retrospectively. RESULTS: The dimension of the surface of the skin island was 178.6cm(2) (72-352cm(2)) in average and the average length of the fibular bony part was 15.4cm (10-23cm). The most frequent and severe complication was skin island edge necrosis (n=7); no total flap necrosis was found. Donor-site morbidity was low, since no joint instability could be reported. Quality of Life was improved according to the standardised FLZ(M) questionnaire. CONCLUSION: Advantages of free osteofasciocutaneous fibula flaps were the wide cortical bone and the relative constant anatomy, the long pedicle, flat, uniform and sufficient large and pliable skin island, as well as the good blood circulation also by massive modelling of the skin and bone part. The skin island could be harvested large enough in order to reconstruct extended soft-tissue defects in the face and the extremities as well as to construct neophallus in its normal size without any restrictions. The lower leg donor-site morbidity was moderate and can be readily covered with a sock in patients' everyday life common activities. Finally, in our hands, the utilisation of the free osteofasciocutaneous fibula flap is the best possible therapy for these difficult composite reconstructions.
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