Reconstruction of oncologic upper extremity defects with fibula free flaps has high union rates and excellent functional outcomes

Limb salvage has better functional outcomes than amputation in the upper extremity. This can however be challenging after bony tumor resections. This is a retrospective case series of patients who underwent humerus, ulna, or radius reconstruction with a fibula free flap. Data were collected on demog...

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Bibliographic Details
Published in:Journal of surgical oncology 2023-12, Vol.128 (8), p.1416-1427
Main Authors: Shahzad, Farooq, Fazzalari, Amanda, Zoghbi, Yasmina, Coriddi, Michelle R, Chapman, Talia R, Mehrara, Babak J, Disa, Joseph J, Cordeiro, Peter G, Healey, John, Athanasian, Edward
Format: Article
Language:English
Subjects:
Activities of Daily Living
Arms
Bone cancer
Bone Neoplasms - surgery
Bone Transplantation
Cancer surgery
Free Tissue Flaps
Humans
Muscular system
Musculoskeletal Diseases
Neoplasms, Connective and Soft Tissue
Pain
Reconstructive surgery
Retrospective Studies
Treatment Outcome
Tumors
Upper Extremity - surgery
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Summary:Limb salvage has better functional outcomes than amputation in the upper extremity. This can however be challenging after bony tumor resections. This is a retrospective case series of patients who underwent humerus, ulna, or radius reconstruction with a fibula free flap. Data were collected on demographics, oncologic history, surgical details, and complications. Functional outcome measures included the patient's ability to perform activities of daily living (ADL), presence of pain, and musculoskeletal tumor society (MSTS) score. Over a 25-year period, 38 reconstructions were performed. The flap success rate was 97.5%. Bony union was obtained in 19 of 19 (100%) forearm reconstructions and in 15 of 19 (79%) humerus reconstructions (p = 0.10). All 19 forearm reconstruction patients and 18/19 humerus reconstruction patients were able to perform ADLs with no pain or only occasional pain. The MSTS scores were not significantly different between the humerus and forearm cohorts (27.1 vs. 27.3, p = 0.68). Functional outcomes were significantly better in limbs that achieved union (p 
ISSN:0022-4790
1096-9098
1096-9098
DOI:10.1002/jso.27418