Akademik Veri Yönetim Sistemi
Congress of the European Federation of Societies for Microsurgery in Prague, Praha, Çek Cumhuriyeti, 14 - 17 Haziran 2026, ss.13, (Özet Bildiri)
Comparison of Free Fibula Flap Inset Techniques in Lower Extremity
Reconstruction After Sarcoma Resection
Bilgehan Bakırel¹, Dicle Yaşar Aksöyler¹, Murat Çelik¹, Ahmet Salduz²
¹ Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul University, Istanbul Faculty
of Medicine, Istanbul, Türkiye
² Department of Orthopedics and Traumatology, Istanbul University, Istanbul Faculty of Medicine,
Istanbul, Türkiye
Introduction:
Reconstructive microsurgery plays a crucial role in managing bone defects following resection of
lower extremity sarcomas. The free fibula flap (FFF) is widely used for this purpose. The flap inset
technique significantly influences postoperative outcomes and can be classified as intramedullary,
intercalary, or onlay. This study aimed to evaluate postoperative outcomes according to different
FFF inset techniques.
Methods:
This retrospective study included patients who underwent lower extremity sarcoma resection
followed by reconstruction with an FFF between May 2013 and September 2024. Demographic
data, pathological diagnoses, recurrence, metastasis, resection length, and complications were
recorded. Bone union time, ISOLS (International Society of Limb Salvage) radiographic scores, and
MSTS (Musculoskeletal Tumor Society) functional scores were compared according to inset
technique.
Results:
Eighteen patients (11 males, 7 females) with a mean age of 17.2 years and mean follow-up of 27.8
months were analyzed. The mean resection length was 14.9 cm. Reconstruction was performed in
the femur (10), tibia (5), and metatarsals (3). Diagnoses included osteosarcoma (6), Ewing sarcoma
(6), pleomorphic sarcoma (3), and chondrosarcoma (2). Lung metastases developed in four patients
and local recurrence occurred in one. The two-year survival rate was 87.7%. Complications
included minor infections (2), FFF fractures (3), fixation failures (3), and non-union (3). The mean
ISOLS score was 21.1. Mean union times were 6.7 months proximally and 9.4 months distally.
Conclusion:
No statistically significant differences were identified among inset techniques regarding ISOLS
scores, union time, or need for revision surgery. Faster proximal union was observed in the onlay
group, whereas distal union was fastest in the intercalary group. Resections exceeding 17 cm were
associated with lower ISOLS scores, delayed distal union, and increased complication and
reoperation rates. FFF reconstruction is a safe and reliable method for limb salvage. Although inset
technique did not significantly alter overall outcomes, careful preoperative planning and
consideration of defect length are essential to optimize union rates and reduce complications.