{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:47:03Z","timestamp":1787755623908,"version":"build-2784847793"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JBJS Rev"],"abstract":"\n Background:<\/jats:title>\n Reconstruction of segmental bone loss due to malignancy, infection, or trauma is a challenge for the reconstructive surgeon. The combination of a vascularized fibular flap with a cortical allograft provides a reliable reconstructive option in the lower extremity. In this systematic review, we describe the outcome of this technique for the treatment of segmental bone loss.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n A systematic review was performed on the use of a combined massive allograft and intramedullary vascularized fibula as a reconstruction method for large bone defects. We used PubMed, Embase, and the Wiley Cochrane Library.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Seventeen clinical articles were included between 1997 and 2017, reporting 329 cases of lower-extremity reconstructions. A meta-analysis was performed on primary union rates. The main outcome measures were primary union rate, complication rate, reintervention rate, and function after reconstruction. All publications showed relatively high complication (5.9% to 85.7%) and reintervention rates (10% to 91.7%) with good primary union rates (66.7% to 100%) and functional outcome (range of mean Musculoskeletal Tumor Society [MSTS] scores, 24 to 29 points).<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n The combination of a massive allograft with intramedullary vascularized fibula provides a single-step reconstruction method for large bone defects (>6 cm) in the lower extremity, with good long-term outcomes.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Therapeutic\n Level IV<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.rvw.18.00166","type":"journal-article","created":{"date-parts":[[2019,8,6]],"date-time":"2019-08-06T08:12:20Z","timestamp":1565079140000},"page":"e2-e2","source":"Crossref","is-referenced-by-count":24,"title":["Combined Massive Allograft and Intramedullary Vascularized Fibula as the Primary Reconstruction Method for Segmental Bone Loss in the Lower Extremity"],"prefix":"10.2106","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5205-5375","authenticated-orcid":false,"given":"Rudolph H.","family":"Houben","sequence":"first","affiliation":[{"name":"VU Medisch Centrum, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2210-6116","authenticated-orcid":false,"given":"Mathijs","family":"Rots","sequence":"additional","affiliation":[{"name":"VU Medisch Centrum, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2456-8480","authenticated-orcid":false,"given":"Stefanie C.M.","family":"van den Heuvel","sequence":"additional","affiliation":[{"name":"VU Medisch Centrum, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9824-8909","authenticated-orcid":false,"given":"Henri A.H.","family":"Winters","sequence":"additional","affiliation":[{"name":"VU Medisch Centrum, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,8]]},"reference":[{"issue":"6","key":"r1-20230801","first-page":"1400","article-title":"What\u2019s new in musculoskeletal oncology","volume":"87","author":"Weber","year":"2005","journal-title":"J Bone Joint Surg Am"},{"issue":"10","key":"r2-20230801","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.2106\/00004623-199274100-00002","article-title":"Vascularized bone transfer","volume":"74","author":"Han","year":"1992","journal-title":"J Bone Joint Surg Am"},{"issue":"3","key":"r3-20230801","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1097\/00000637-200109000-00004","article-title":"Upper limb salvage with microvascular bone transfer for major long-bone segmental tumor resections","volume":"47","author":"Gao","year":"2001","journal-title":"Ann Plast Surg"},{"issue":"4","key":"r4-20230801","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.bjps.2004.11.002","article-title":"Vascularised free fibular flap in bone resection and reconstruction","volume":"58","author":"Belt","year":"2005","journal-title":"Br J Plast Surg"},{"issue":"3","key":"r5-20230801","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1055\/s-2006-939963","article-title":"Indications and outcomes of free tissue transfer to the lower extremity in children: review","volume":"22","author":"Organek","year":"2006","journal-title":"J Reconstr Microsurg"},{"issue":"Suppl 5","key":"r6-20230801","doi-asserted-by":"crossref","first-page":"S36","DOI":"10.1097\/BOT.0000000000000979","article-title":"Induced membrane technique: pearls and pitfalls","volume":"31","author":"Masquelet","year":"2017","journal-title":"J Orthop Trauma"},{"issue":"1","key":"r7-20230801","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s00068-014-0451-2","article-title":"Reconstruction of post-traumatic long segment bone defects of the lower end of the femur by free vascularized fibula combined with allograft (modified Capanna\u2019s technique)","volume":"41","author":"Venkatramani","year":"2015","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"5","key":"r8-20230801","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1007\/s00590-013-1261-7","article-title":"Risk factors for and complications of distraction osteogenesis","volume":"24","author":"Liantis","year":"2014","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"6","key":"r9-20230801","doi-asserted-by":"crossref","first-page":"793","DOI":"10.2106\/00004623-199806000-00003","article-title":"Distraction osteogenesis of the lower extremity with use of monolateral external fixation. 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Meta-Analysis"],"short-title":[],"issued":{"date-parts":[[2019,8]]},"references-count":35,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.rvw.18.00166","relation":{},"ISSN":["2329-9185"],"issn-type":[{"value":"2329-9185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8]]}}}