Free Vascularized Fibula Grafting in the Operative Treatment of Malignant Bone Tumors of the Upper Extremity: A Systematic Review of Outcomes and Complications

BACKGROUND AND OBJECTIVES: Vascularized bone grafting after tumor resection can be an important component in the treatment of bony neoplasms of the upper extremity. The radiographic, clinical, and patient-centered outcomes following VBG of the upper extremity have been reported in several studies; however, no large-scale analysis of outcomes has been performed and no standardization of reporting exists. The purpose of this study was to determine the outcomes of free vascularized fibula grafting (FVFG) in the treatment of upper extremity sarcomas and analyze the reporting of specific clinical and patient-centered parameters during follow-up.

METHODS: A systematic review of the literature of FVFG used in the treatment of upper extremity sarcomas was performed. We excluded case reports and studies in which data was aggregated from multiple different procedures for various diagnoses. The outcomes assessed were patient demographics, classification and location of the tumor, the use of preoperative and/or postoperative radiation and/or chemotherapy, bony union, and patient-centered outcomes.

RESULTS: A total of 56 studies were included in final analysis. The most common diagnosis was osteosarcoma (35.1%) and the most common recipient site was the humerus (57.3%) followed by the radius (36.2%) and ulna (5.8%). FVFG had a median union rate of 93.3%, with the median time to union being 5.0 months. The most common complications were fracture (11.7%), nerve injury (7.5%), infection (5.7%), and hammer toe deformity (3.3%). The reoperation rate was 34.5%. The most commonly reported standardized assessment of clinical outcomes following treatment was the Musculoskeletal Tumor Society Score, which had a mean of 79% and a median of 80% postoperatively.

CONCLUSIONS: FVFG in the treatment of malignant bony neoplasms of the upper extremity has a high rate of union and good overall outcomes; however, postoperative complication rates are high. A greater degree of standardization is needed in the reporting of patient-centered outcomes. Reporting outcomes of individual patients or stratifying data based on diagnosis, graft site, and age would facilitate future comparative studies.