{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T18:47:40Z","timestamp":1773600460432,"version":"3.50.1"},"reference-count":31,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Advances in orthopedic oncology have significantly improved outcomes following extremity tumor resections; however, complications like nonunion, hardware failure, and radiation\u2010induced fractures can occur after orthopedic fixation. While the vascularized fibula\u2010free flap (FFF) is well\u2010established in primary reconstructions, its effectiveness as a salvage option is not well described. We report our 25\u2010year experience with the use of FFF in salvage extremity reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective case series included patients undergoing extremity salvage with FFF after failure of primary oncologic reconstructions from 1995 to 2021. Demographics, surgical indications, reconstructive details, functional outcomes, complications, and Musculoskeletal Tumor Society (MSTS) scores were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifteen patients (ages 6\u201371 years) met inclusion criteria, which included nine humeral and six femoral reconstructions, with an average follow\u2010up of 6.7 years. Indications for salvage were radiation\u2010induced fracture (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096), nonunion (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093), allograft fracture (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093), and hardware failure (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093). The median interval between the initial surgery for tumor resection and FFF for limb salvage was 4 years 3 months (mean: 9 years, range: 10 months to 29.3 years). All lower\u2010extremity reconstructions achieved full weight\u2010bearing without pain. Upper\u2010extremity reconstructions resulted in full functional restoration in six patients and minor functional deficits in three. Bony union of fibula flap was achieved in 78.5% patients. Reoperation were performed in 4 patients for wound issues (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092) and hardware removal (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>FFF is a reliable and effective option for management of oncologic\u2010related complications of the extremities. It can avoid amputations and improve limb function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70170","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T13:32:04Z","timestamp":1766496724000},"page":"371-381","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Fibula Free Flap for Salvage of Complications After Orthopedic Extremity Bony Fixation in Oncologic Patients"],"prefix":"10.1002","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0187-8336","authenticated-orcid":false,"given":"Jacob","family":"Levy","sequence":"first","affiliation":[{"name":"Plastic &amp; Reconstructive Surgery Service Memorial Sloan\u2010Kettering Cancer Center New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis D.","family":"Graziano","sequence":"additional","affiliation":[{"name":"Plastic &amp; Reconstructive Surgery Service Memorial Sloan\u2010Kettering Cancer Center New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronnie L.","family":"Shammas","sequence":"additional","affiliation":[{"name":"Plastic &amp; Reconstructive Surgery Service Memorial Sloan\u2010Kettering Cancer Center New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8864-4083","authenticated-orcid":false,"given":"Evan","family":"Matros","sequence":"additional","affiliation":[{"name":"Plastic &amp; Reconstructive Surgery Service Memorial Sloan\u2010Kettering Cancer Center New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Coriddi","sequence":"additional","affiliation":[{"name":"Plastic &amp; Reconstructive Surgery Service Memorial Sloan\u2010Kettering Cancer Center New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph J.","family":"Disa","sequence":"additional","affiliation":[{"name":"Plastic &amp; Reconstructive Surgery Service Memorial Sloan\u2010Kettering Cancer Center New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Babak J.","family":"Mehrara","sequence":"additional","affiliation":[{"name":"Plastic &amp; Reconstructive Surgery Service Memorial Sloan\u2010Kettering Cancer Center New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter G.","family":"Cordeiro","sequence":"additional","affiliation":[{"name":"Plastic &amp; Reconstructive Surgery Service Memorial Sloan\u2010Kettering Cancer Center New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7758-8015","authenticated-orcid":false,"given":"Farooq","family":"Shahzad","sequence":"additional","affiliation":[{"name":"Plastic &amp; Reconstructive Surgery Service Memorial Sloan\u2010Kettering Cancer Center New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/canjclin.47.4.226"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000001419"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1155\/2007\/62151"},{"issue":"2","key":"e_1_2_11_5_1","first-page":"81","article-title":"The Use of Massive Bone Allografts for Intercalary Reconstruction and Arthrodeses After Tumor Resection. 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