Parallel reconstruction of vascularized fibula autograft for treatment of complications after resection of malignant tumor from the thigh

Abstract

Summary: The authors herein introduce a modification of parallel reconstruction with a vascularized fibula autograft (VFA) for cases of femur allograft complications. Conventional parallel reconstruction, in which the fibula with its vascular pedicle is placed on the medial side of the femur and allogeneic bone, may be an effective means to solve the allograft complications. However, the limited contact area between the fibula and femur/allogeneic bone can affect the bone healing ability. Furthermore, the rigid internal fixation method for the VFA may cause stress shielding and result in bone resorption. The authors propose the use of modified parallel reconstruction of the VFA with fibula expansion and titanium cable fixation for patients with allograft–host junction nonunion, allogeneic bone fracture, and femoral shaft fracture after surgical removal of a malignant tumor from the thigh. The modified parallel reconstruction has been performed on 5 patients (2 patients underwent fibular expansion). All 5 patients with 7 nonunion of allograft-host junction or fracture were followed up 33.2 months. The length of fibular graft is 10-20cm, with an average of 15.0 cm. The union rate of allograft-host junction and fracture was 100% (7/7), and the union time 15.9 months. This modified parallel reconstruction technique can achieve satisfactory union in treatment of the above complications.