Limb-saving surgery in osteosarcoma by vascularized fibular graft

Osteosarcoma is the most malignant bone tumor of the extremities that occurs in younger age groups; however, the prognosis of this disease has been improving. Limb-saving procedures have been successfully performed in more than half of the new cases of this disease. Because osteosarcoma occurs in young patients and their life expectancy is generally long, the rescued limbs must provide as full a service as possible for several decades. We have attempted the rescue of limbs in osteosarcoma patients, using the vascularized fibular graft (VFG). We performed a retrospective clinical and radiographic review of 12 patients with at least 3 years of follow up. The results were satisfactory in 11 out of the 12 patients from both the oncologic and functional point of view. There were no severe complications or donor site morbidity. Functional status, evaluated according to the system of Enneking et al. (Enneking WF, Dunham W, Gebhart MC, et al. A system for functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop 1993;286:241–246), with some modifications exceeded 80%, except in one patient. The results of this study suggest that, because of the resulting durability of the reconstructed limb, VFG should be considered for limb rescue in young patients with osteosarcoma.