[Experiences with vascular pedicled fibula in reconstruction of osseous defects in primary malignant bone tumors].

To bridge large bone defects after resection of primary malignant bone tumors, an autologous free vascularized fibular graft was used in 31 patients (15 x upper limb, 16 x lower limb). The median bone defect measured 16 cm (7-29.5 cm). At the lower extremity the vascularized fibular transplant was reinforced with an allograft and different osteosyntheses. At the upper limb stabilization of the transplant was obtained exclusively by plate osteosynthesis or condylar plate. Applications and the authors' experiences are described and discussed in terms of clinical outcome, graft union, functional outcome, and complications for each localization. After a median of 48 months, ten complications at the upper limb and eight complications at the lower limb, respectively, were seen requiring secondary surgical revision. Major complications such as perioperative deaths or secondary amputations were not observed. Functional evaluation showed better results for the lower than for the upper extremity, due mainly to en bloc resection of proportionally large amounts of soft tissues around the shoulder girdle for local tumor control. Despite the demanding operative procedure and a large number of controllable complications, the good functional outcome and high patient satisfaction indicate that the free vascularized fibular graft is an option for limb-sparing surgery of primary malignant bone tumors.