Restoration of Spinopelvic Continuity with the Free Fibula Flap after Limb-Sparing Oncologic Resection Is Associated with a High Union Rate and Superior Functional Outcomes

Abstract

Background: Type 1 internal hemipelvectomies and total sacrectomies cause significant biomechanical instability, demanding pelvic ring reconstruction for ambulation and torso support. Previously described methods include autografts, allografts, and implants, commonly with poor long-term outcomes. The authors hypothesized that the free fibula flap for spinopelvic reconstruction is safe and effective, and associated with a high bony union rate and superior functional outcomes. Methods: The authors performed a retrospective review of all patients who underwent free fibula flap surgery after internal hemipelvectomy or total sacrectomy at M. D. Anderson Cancer Center from 2003 to 2018. The primary outcome was radiographic evidence of bony union. Secondary outcomes included surgical-site occurrence and lower extremity function. Univariate and multivariate logistic regression analyses were performed. Results: Forty-seven patients were included (internal hemipelvectomy, n = 38; total sacrectomy, n = 9). The mean follow-up was 3.3 years and the most common abnormality was chondrosarcoma (30.4 percent). The nonunion rate was 9.7 percent and the surgical-site occurrence rate was 34 percent; there were no flap losses. Greater age was significantly associated with nonunion (OR, 1.1; 95 percent CI, 1 to 1.2; p = 0.003), whereas obesity was the only independent predictor of surgical-site occurrence (OR, 9.2; 95 percent CI, 1.2 to 71.3; p = 0.03). Functional metrics approached those of adult norms by 3 years postoperatively. Compared to internal hemipelvectomy patients, patients undergoing total sacrectomy had more comorbidities, a higher complication rate, and a worse functional outcome. Conclusion: The free fibula flap for spinopelvic reconstruction is safe and effective, and is associated with a high bony union rate and superior functional outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Pelvic ring reconstruction with double‐barreled fibular free flap: A systematic review

“…Autologous bony reconstruction of the pelvis using fibula has been widely described in the literature (Chao et al, 2015; Mericli et al, 2020). Yajima and Tamai reported the first two cases of pelvic reconstruction using double‐strut vascularized fibula flaps (Yajima & Tamai, 1994).…”

75 Years of Excellence: The Story of Reconstructive Surgery

“…The innovative use of tissue and osseous flaps enhanced with the application of computer-aided design/computer-aided modeling technology has reduced short-and long-term complication rates and enabled patients to remain ambulatory. [27][28][29][30][31] The invention of negative-pressure wound therapy in 1997 provided plastic surgeons the option of temporizing wounds and revolutionized the management of lower extremity trauma. 32 One of the earliest pioneers of lower extremity reconstruction, Marco Godina, described the importance of addressing bone and soft-tissue components within 72 hours after trauma.…”

“…The innovative use of tissue and osseous flaps enhanced with the application of computer-aided design/computer-aided modeling technology has reduced short- and long-term complication rates and enabled patients to remain ambulatory. 27–31…”

Entnahmemorbidität beim Fibulatransplantat

“…Darüber hinaus wird das FFF zur Rekonstruktion der langen Röhrenknochen, speziell nach extremitätenerhaltender onkologischer Resektion, Rekonstruktionen nach Hemipelvektomien, Sakrektomien und im Bereich der Wirbelsäule verwendet (▶ Abb. 1) [8,9,10]. Im muskuloskelettalen Bereich wird insbesondere bei einer Defektgröße von > 6-8 cm und zur Gelenkrekonstruktion ein vaskulärer Anschluss empfohlen [8].…”