FREE FIBULA FLOW THROUGH OSTEOCUTANEOUS FLAP IN THE UPPER EXTREMITY SARCOMA RECONSTRUCTION

• Published in: Journal of evolution of medical and dental sciences Vol. 4; no. 26; pp. 4464 - 4472
• Main Author: Sivarajan, N
• Format: Journal Article
• Language: English
• Published: Akshantala Enterprises Private Limited 30.03.2015
• Subjects: Cancer; Chemotherapy; Histochemistry; Sarcoma
• ISSN: 2278-4748; 2278-4802
• DOI: 10.14260/jemds/2015/645

INTRODUCTION: With the evolution of modern reconstructive methods amputations for malignant tumours of the upper limb can be prevented. Of all the methods, the free fibula is most commonly used to bridge bone gaps during limb salvage. OBJECTIVE: to study the effectiveness of flow through fibula osteocutaneous flap in the reconstruction of upper extremity following oncological excision of forearm sarcomas, where both axial vessels are excised or dominant vessel is excised. MATERIALS: This study was conducted between March 2012 to March 2013 at our institute. A total of 6 cases (4 male and 2 female) aged between 19 and 40 years with Soft tissue sarcoma of the forearm were treated with Wide Local Excision and reconstruction using flow through osteocutaneous fibula flap. Of these, 4 patients had both the ulnar and radial arteries removed and in 2 patients the dominant/codominant radial aretery was removed. The 4 patients in the first group received post op RT and the other 2 patients received post op chemotherapy. All patients were followed up for a mean period of 9 months. RESULTS: Histopathology was varied-- Spindle cell sarcoma (2 pts), synoviosarcoma (2 pts), osteosarcoma (1 pt) and fibrosarcoma (1 pt). All the tumours were located in the distal 1/3rd of the forearm. All the flaps survived, and all the patients had good to reasonable hand function at follow up. One patient developed pulmonary metastasis and 1 patient developed CRPS type 2. CONCLUSION: Amputation of the upper limb was thought to be the best approach for STS of the forearm. With the flow through flaps the vascularity and function of the hand can be maintained. Thus an irreplaceable vital organ, namely hand, can be saved with these flaps. The missing vascular conduit is reestablished and at the same time, bone and soft tissue is reconstructed. KEYWORDS: Flow through fibula, Osteocutaneous, Sarcoma, Limb preservation surgery.