Complications of vascularized fibula reconstructions.

Aims:Vascularized fibula has been widely used in limb salvage surgery to reconstruct large bone defects. Aim of this study is the analysis of the complications related both to the donor and the recipient site in a series of patients affected by bone tumors. Material and methods: In the period from 1988 to 2002, 114 patients ranging in age between 4 and 64 years underwent bone reconstruction by mean of a vascularized fibula graft. There were 64 men and 50 women and all them were affected by malignant neoplasm. The upper limb was involved in 25 cases and the lower extremity in 89 cases. The length of resection ranged between 7 and 28 cm, the follow up between 6 and 166 months. Results: Several complications have been noted either at the donor or at the recipient site. The most common complications affecting the donor leg, have been the retraction of flexor tendons (6), the valgus deformity of the ankle (3) the retraction of extensor hallucis longus (1) and a transient palsy of the peroneal nerve (1). The most frequent complications observed at the recipient site has been a fracture of the graft (15) followed by non union (12), infection (5 cases), failure of plate (5), skin necrosis (4), transient palsy of the peroneal nerve (3) and joint stiffness. Because of complications, a total failure of the procedure occurred in 4 cases. Conclusions: Although the vascularized fibula graft is the recommended procedure in dealing with challenging reconstruction of large diaphyseal defects, this option is not free of complications. However, in our experience, when conservative treatment of complications was not successful, further surgery was able to lead to recovery in the majority of cases