Limb salvage in malignant tumours of the upper limb using vascularised fibula.

INTRODUCTION: Modern reconstructive techniques can prevent amputation in most cases of malignant musculoskeletal tumours. The free fibula has emerged as the primary method of bridging long bone gaps during limb salvage.

METHODS: Limb salvage was attempted in 23 patients (15 males and eight females) aged 17-57 years. The tumour was located in the humerus in 18 patients, radius in four patients and the metacarpals in one patient. Osteogenic sarcoma was the most common tumour (11 cases) followed by Ewing's sarcoma in six patients. After neoadjuvant chemotherapy, MRI was repeated and resectability assessed. Wide local excision was performed and the bony defect bridged by free fibulae.

RESULTS: All the flaps survived. The average length of defect reconstructed was 18 cm and the average time for bone union was 7 months. At a minimum follow up of 12 months, 21 patients were alive and disease free. One patient required amputation due to recurrence and one died of metastatic disease. Secondary surgery was needed in eight patients (five tendon transfers, two latissimus dorsi flap readjustments and one bone graft). Overall patient satisfaction was high with 21/23 patients having a useful limb.

CONCLUSION: Limb salvage in the upper limb using vascularised fibula in patients with malignant musculoskeletal tumours can result in good tumour control along with reasonable limb function.