Free Vascularized Fibula Grafting for Malignant Bone Tumors of the Upper Extremity | Dr. Daniel Gould

Dr. Daniel Gould co-authored this systematic review published in Plastic and Reconstructive Surgery Global Open, examining outcomes and complications associated with free vascularized fibula grafting for the reconstruction of upper extremity defects following the removal of malignant bone tumors. 

Removing a malignant bone tumor from the arm can leave a substantial skeletal defect that requires complex reconstruction. Free vascularized fibula grafting involves transferring a segment of the fibula together with its blood supply, providing living bone that can integrate with the recipient site and support long-term reconstruction.

The researchers systematically reviewed 56 studies evaluating this technique in patients with upper extremity sarcomas. Osteosarcoma was the most commonly represented diagnosis, while the humerus was the most frequent reconstruction site, followed by the radius and ulna.

Across the studies, free vascularized fibula grafting demonstrated a median bone union rate of 93.3%, with a median time to union of approximately five months. These findings highlight the technique's ability to achieve reliable skeletal healing following extensive tumor resection.

The review also identified important complications, including fractures, nerve injuries, infections, and donor-site concerns. Reoperations were relatively common, emphasizing the complexity of these reconstructions even when successful bone union is achieved.

The authors concluded that free vascularized fibula grafting can provide strong overall outcomes for reconstruction following malignant upper extremity bone tumors, while also highlighting the need for more standardized reporting of functional and patient-centered outcomes in future research.