{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:05:10Z","timestamp":1792789510218,"version":"4.5.0"},"reference-count":40,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,12,5]],"date-time":"2022-12-05T00:00:00Z","timestamp":1670198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81872182"],"award-info":[{"award-number":["81872182"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81802685"],"award-info":[{"award-number":["81802685"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82173343"],"award-info":[{"award-number":["82173343"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["SHDC2020CR3019A"],"award-info":[{"award-number":["SHDC2020CR3019A"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Shenkang Three-year Action Plan","award":["81872182"],"award-info":[{"award-number":["81872182"]}]},{"name":"Shenkang Three-year Action Plan","award":["81802685"],"award-info":[{"award-number":["81802685"]}]},{"name":"Shenkang Three-year Action Plan","award":["82173343"],"award-info":[{"award-number":["82173343"]}]},{"name":"Shenkang Three-year Action Plan","award":["SHDC2020CR3019A"],"award-info":[{"award-number":["SHDC2020CR3019A"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>This study aimed to evaluate the clinical outcomes and complications of reconstruction with a composite free fibula inside other biological grafts. We retrospectively reviewed 26 patients who underwent reconstruction after bone tumor resection of the diaphysis of the long bone. Surgical data, time to bony union, functional outcomes, and complications were evaluated in all cases. The median follow-up was 72.5 months. The limb salvage rate was 100%. Primary osseous union was achieved in 90.4% of the junctions. The union rates at the metaphyseal and diaphyseal junctions were 100% and 85.7%, respectively (p = 0.255). The mean time of bony union in the upper (87.5%) and lower (91.7%) extremity was 4.6 \u00b1 1.6 months and 6.9 \u00b1 2 months, respectively. The mean MSTS score was 27.2 \u00b1 3.2, with a mean MSTS rating of 90.7%. Complications occurred in 15.4% of the cases. The administration of vascularized or non-vascularized grafts did not significantly influence the union time (p = 0.875), functional outcome (p = 0.501), or blood loss (p = 0.189), but showed differences in operation time (p = 0.012) in lower extremity reconstruction. A composite free fibula inside other biological grafts provides a reasonable and durable option for osseous oncologic reconstruction of the long bone diaphysis of the extremities with an acceptable rate of complications. A higher union rate was achieved after secondary bone grafting. In lower-extremity reconstruction, two plates may be considered a better option for internal fixation. Vascularizing the fibula did not significantly affect the union time.<\/jats:p>","DOI":"10.3390\/jcm11237225","type":"journal-article","created":{"date-parts":[[2022,12,5]],"date-time":"2022-12-05T07:07:31Z","timestamp":1670224051000},"page":"7225","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Long-Term Follow-Up of Biological Reconstruction with Free Fibular Graft after Resection of Extremity Diaphyseal Bone Tumors"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6447-1675","authenticated-orcid":false,"given":"Zhaohui","family":"Li","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3773-550X","authenticated-orcid":false,"given":"Xiang","family":"Fei","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongdong","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingcheng","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,5]]},"reference":[{"key":"ref_1","first-page":"501","article-title":"Quality of Life Following Surgical Treatment of Lower Limb Metastases in Long Bone","volume":"29","author":"Perisano","year":"2015","journal-title":"J. Biol. Regul. Homeost. Agents"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.jbo.2016.01.001","article-title":"A comparative study between limb-salvage and amputation for treating osteosarcoma","volume":"5","author":"Li","year":"2016","journal-title":"J. Bone Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1007\/s13193-018-0725-y","article-title":"Limb Salvage Versus Amputation in Conventional Appendicular Osteosarcoma: A Systematic Review","volume":"9","author":"Jauregui","year":"2018","journal-title":"Indian J. Surg. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1302\/0301-620X.99B9.BJJ-2017-0219.R1","article-title":"Vascularised fibular grafts for reconstruction of extremity bone defects after resection of bone and soft-tissue tumours: A single institutional study of 49 patients","volume":"99-B","author":"Emori","year":"2017","journal-title":"Bone Jt. J."},{"key":"ref_5","first-page":"85","article-title":"Application of the free vascularized bone graft in the treatment of malignant or aggressive bone tumors","volume":"140","author":"Weiland","year":"1977","journal-title":"Johns Hopkins Med. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/2309499019832970","article-title":"Reconstruction of intercalary bone defect after resection of malignant bone tumor","volume":"27","author":"Zekry","year":"2019","journal-title":"J. Orthop. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1007\/s00590-017-1985-x","article-title":"Intercalary reconstructions after bone tumor resections: A review of treatments","volume":"27","author":"Panagopoulos","year":"2017","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1097\/PRS.0b013e3182362171","article-title":"Composite Extremity and Trunk Reconstruction with Vascularized Fibula Flap in Postoncologic Bone Defects: A 10-year experience","volume":"129","author":"Clemens","year":"2012","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1007\/s11999-009-1053-x","article-title":"Free Vascularized Fibular Graft Reconstruction of Large Skeletal Defects after Tumor Resection","volume":"468","author":"Eward","year":"2009","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e12605","DOI":"10.1097\/MD.0000000000012605","article-title":"Long-term follow-up of fibular graft for the reconstruction of bone defects","volume":"97","author":"Liu","year":"2018","journal-title":"Medicine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"861575","DOI":"10.1155\/2015\/861575","article-title":"Intercalary Reconstruction after Wide Resection of Malignant Bone Tumors of the Lower Extremity Using a Composite Graft with a Devitalized Autograft and a Vascularized Fibula","volume":"2015","author":"Ogura","year":"2015","journal-title":"Sarcoma"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1002\/jso.25032","article-title":"Free vascularized fibula grafting in the operative treatment of malignant bone tumors of the upper extremity: A systematic review of outcomes and complications","volume":"117","author":"Landau","year":"2018","journal-title":"J. Surg. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s00590-018-2360-2","article-title":"Microsurgical reconstruction with vascularized fibula and massive bone allograft for bone tumors","volume":"29","author":"Errani","year":"2018","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_14","first-page":"101","article-title":"Induced membrane by silver-coated knee megaprosthesis: Keep or toss?","volume":"34","author":"Vitiello","year":"2020","journal-title":"J. Biol. Regul. Homeost. Agents"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1302\/0301-620X.92B6.23449","article-title":"Femoral diaphyseal endoprosthetic reconstruction after segmental resection of primary bone tumours","volume":"92","author":"Hanna","year":"2010","journal-title":"J. Bone Jt. Surgery. Br. Vol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2885","DOI":"10.1007\/s11999-010-1454-x","article-title":"Late Complications and Survival of Endoprosthetic Reconstruction after Resection of Bone Tumors","volume":"468","author":"Shehadeh","year":"2010","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1007\/s00264-017-3446-x","article-title":"Intercalary frozen autograft for reconstruction of malignant bone and soft tissue tumours","volume":"41","author":"Zekry","year":"2017","journal-title":"Int. Orthop."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1302\/0301-620X.100B3.BJJ-2017-0283.R2","article-title":"Intercalary reconstruction of femur after tumour resection: Is a vascularized fibular autograft plus allograft a long-lasting solution?","volume":"100-B","author":"Campanacci","year":"2018","journal-title":"Bone Jt. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1055\/s-2001-16597","article-title":"Skeletal Reconstruction with a Free Vascularized Fibula Graft Associated to Bone Allograft After Resection of Malignant Bone Tumor of Limbs","volume":"33","author":"Ceruso","year":"2001","journal-title":"Handchir. Mikrochir. Plast. Chir."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1111\/os.12646","article-title":"Clinical Outcome of Free Vascularized Fibula Graft in the Surgical Treatment of Extremity Osteosarcoma","volume":"12","author":"Xu","year":"2020","journal-title":"Orthop. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1055\/s-0036-1581075","article-title":"Free Vascularized Fibular Graft is Reliable in Upper Extremity Long-Bone Reconstruction with Good Long-Term Outcomes","volume":"32","author":"Sommarhem","year":"2016","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1302\/0301-620X.102B5.BJJ-2019-1380.R1","article-title":"Is frozen tumour-bearing autograft with concurrent vascularized fibula an alternative to the Capanna technique for the intercalary reconstruction after resection of osteosarcoma in the lower limb?","volume":"102-B","author":"Lu","year":"2020","journal-title":"Bone Jt. J."},{"key":"ref_23","first-page":"925413","article-title":"Allograft Reconstruction for the Treatment of Musculoskeletal Tumors of the Upper Extremity","volume":"2013","author":"Ayerza","year":"2013","journal-title":"Sarcoma"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1007\/s11999-009-1186-y","article-title":"Proximal Tibia Osteoarticular Allografts in Tumor Limb Salvage Surgery","volume":"468","author":"Muscolo","year":"2010","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_25","first-page":"892141","article-title":"Epiphyseal Sparing and Reconstruction by Frozen Bone Autograft after Malignant Bone Tumor Resection in Children","volume":"2015","author":"Abdelaal","year":"2015","journal-title":"Sarcoma"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1186\/s12891-022-05840-6","article-title":"Intercalary frozen autografts for reconstruction of bone defects following meta-\/diaphyseal tumor resection at the extremities","volume":"23","author":"Yang","year":"2022","journal-title":"BMC Musculoskelet. Disord."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1097\/CORR.0000000000001639","article-title":"Does the Addition of a Vascularized Fibula Improve the Results of a Massive Bone Allograft Alone for Intercalary Femur Reconstruction of Malignant Bone Tumors in Children?","volume":"479","author":"Errani","year":"2021","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jcot.2021.04.033","article-title":"Intercalary reconstruction following resection of diaphyseal bone tumors: A systematic review","volume":"19","author":"Errani","year":"2021","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1002\/jso.21620","article-title":"The use of allograft shell with intramedullary vascularized fibula graft for intercalary reconstruction after diaphyseal resection for lower extremity bony malignancy","volume":"102","author":"Li","year":"2010","journal-title":"J. Surg. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1007\/s11999-016-5196-2","article-title":"Is There Benefit to Free Over Pedicled Vascularized Grafts in Augmenting Tibial Intercalary Allograft Constructs?","volume":"475","author":"Manfrini","year":"2016","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1007\/s00132-017-3442-2","article-title":"Die autologe Fibulatransplantation zur Rekonstruktion kn\u00f6cherner Defekte","volume":"46","author":"Lenze","year":"2017","journal-title":"Der Orthop\u00e4de"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1186\/s12891-017-1640-z","article-title":"Non-vascularised fibula grafts for reconstruction of segmental and hemicortical bone defects following meta- \/diaphyseal tumour resection at the extremities","volume":"18","author":"Lenze","year":"2017","journal-title":"BMC Musculoskelet. Disord."},{"key":"ref_33","first-page":"2701","article-title":"Vascularized bone graft for oncological reconstruction of the extremities: Review of the biological advantages","volume":"34","author":"Muramatsu","year":"2014","journal-title":"Anticancer Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1302\/0301-620X.96B9.33230","article-title":"Vascularised or non-vascularised autologous fibular grafting for the reconstruction of a diaphyseal bone defect after resection of a musculoskeletal tumour","volume":"96-B","author":"Schuh","year":"2014","journal-title":"Bone Jt. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1097\/PRS.0000000000004794","article-title":"Comparison of Pediatric Intercalary Allograft Reconstructions with and without a Free Vascularized Fibula","volume":"142","author":"Houdek","year":"2018","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e833","DOI":"10.1097\/BPO.0000000000001640","article-title":"Intercalary Allograft Reconstruction of the Proximal Tibia with and Without a Free Fibula Flap in Pediatric Patients","volume":"40","author":"Misaghi","year":"2020","journal-title":"J. Pediatr. Orthop."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1016\/j.bjps.2016.02.018","article-title":"Extracorporeally frozen tumour-bearing bone combined with free vascularised fibula for the intercalary reconstruction of femoral defect after resection of bony sarcoma","volume":"69","author":"Li","year":"2016","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1007\/s11999-011-1952-5","article-title":"Intercalary Femur Allografts Are an Acceptable Alternative After Tumor Resection","volume":"470","author":"Farfalli","year":"2012","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1097\/01.blo.0000179586.34727.5b","article-title":"Vascularized Free Fibula Transfer for Oncologic Reconstruction of the Humerus","volume":"438","author":"Rose","year":"2005","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1002\/jso.20326","article-title":"Free vascularized fibular grafting for reconstruction after tumor resection in the upper extremity","volume":"94","author":"Gebert","year":"2006","journal-title":"J. Surg. Oncol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/23\/7225\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:34:20Z","timestamp":1760146460000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/23\/7225"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,5]]},"references-count":40,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["jcm11237225"],"URL":"https:\/\/doi.org\/10.3390\/jcm11237225","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,5]]}}}