Vascularized fibular autograft as salvage technique in failure of allograft intercalary reconstructions after tumor resections

Intercalary allografts after diaphyseal resections for bone tumors represent the most frequent option of reconstruction. Main complications are non-unions, fractures and infections. The purpose of the current study was to report our experience with the use of vascularized fibular autograft as rescue technique in failed previous reconstructions after intercalary bone tumor resection of the extremities. Twenty-eight patients were followed over time. Causes of failure were non-union, allograft fracture and infection. Vascularized fibular autograft was used with mechanical support of massive bone allograft in 13 cases. Functional results were excellent in 19 cases, good in 8 and fair in one patient. Among complications we reported 4 non-unions, 2 allograft fractures, 1 non-union with plate breakage, 1 plate breakage, 1 infection, 1 limb shortening and 1 knee varus deformity. The rationale of vascularized fibular autograft is to provide biologic support. The association with massive bone allograft provides mechanical strength and early stability.