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The free vascularized fibula flap for long bone reconstruction in adults — a systematic review and regional centre experience

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Abstract

Background

The free vascularized fibula flap (FVFF) has proven a versatile means of reconstruction since its first description. Its broad spectrum of applications includes limb and craniofacial reconstruction following oncological resection and trauma.

Methods

A retrospective chart review was carried out on patients undergoing FVFF reconstruction in our centre between 1993 and 2021. The surgical indication, intraoperative technique and post-operative outcomes were recorded. A systematic review was conducted using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines specifically regarding long bone reconstruction with FVFF in adult patients. This enabled a comparison to parameters assessed in our case series as well as a recently published systematic review on FVFF reconstruction in the paediatric population.

Results

In our centre, 15 patients underwent FVFF reconstruction for indications including osteomyelitis and following tumour resection. Mean time to bony union of the FVFF was 7 months and we report a low incidence of post-operative complications. In the systematic review we identified 369 adult patients across 47 studies. The most common indications for FVFF were tumour resection or traumatic bone loss. A quarter of patients had reconstructions incorporating a bony allograft in addition to the FVFF. The mean time to union was 6 months. Functional evaluation using patient reported scoring systems demonstrated excellent results with low rates of donor site morbidity.

Conclusions

This systematic review highlights the versatility of the FVFF in long bone reconstruction of the limbs. This review provides clarification on the low morbidity associated with this procedure and the high functional outcomes as reported by the patients themselves.

Level of evidence: Level IV, Risk/Prognostic; Therapeutic.

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Plastic Surgery, Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast, BT16 1RH, Northern Ireland

    Neala Glynn, Serena Martin & Harry Lewis

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  1. Neala Glynn
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  2. Serena Martin
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  3. Harry Lewis
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Correspondence to Neala Glynn.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This is an observational case series and systematic review — no ethical approval required.

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The authors affirm that patients approval was sought to share their data and publish their images in Figs. 2, 3, and 4.

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Neala Glynn, Serena Martin, and Harry Lewis declare no conflict of interest.

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Glynn, N., Martin, S. & Lewis, H. The free vascularized fibula flap for long bone reconstruction in adults — a systematic review and regional centre experience. Eur J Plast Surg 46, 1199–1211 (2023). https://doi.org/10.1007/s00238-023-02082-0

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