Biological reconstruction using massive bone allograft with intramedullary vascularized fibular flap after intercalary resection of humeral malignancy


  • Author Zhen Wang has contributed equally to this paper and also co-first authors for this article.

  • Conflict of interest statement: We, Jing Li, Zhen Wang, Zheng Guo, Guoxian Pei, declare that we have no proprietary, financial, professional or other interest of any nature or kind in any product, service, and/ or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled “Biological reconstruction using massive bone allograft with intramedullary vascularized fibular flap after intercalary resection of humeral malignancy.” The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.



Reconstruction after excision of the humeral malignancy is a challenging issue for the reconstructive surgeon. The combined use of a fibular flap and allograft can provide a reliable reconstructive option. This article describes the authors' experience with this technique for the treatment of segmental bone defects after resection of humeral malignancy.


From 2005 to 2008, seven patients that had intercalary resection of humeral malignancy underwent reconstruction with an allograft and vascularized fibula construct. Patients were examined clinically and radiographically.


The average age at time of operation was 16.7 years. The mean follow-up time was 27.7 months. The average length of the resected humeral segment was 10.6 cm and that of the fibula flap was 13.1 cm. The average time of union of fibula was 20.7 weeks and for union of allograft was 26.3 weeks. Incorporation of the fibula into the allograft was seen in three patients. There were no allograft fractures and no infections. Three patients had surgery-related complications including a temporary radial nerve paralysis in 1, wound dehiscence in 1, and clawed toes in 1. The MSTS average score was 95.2% at final follow-up.


Intramedullary fibular flaps in combination with massive allografts provide an excellent option for reconstruction of large bony defects after humeral malignancy extirpation. The viability of the fibula is a cornerstone in success of reconstruction that prevents allograft nonunion and result in decreased time to bone healing, leading to earlier patient recovery and return of function. J. Surg. Oncol. 2011; 104:244–249. © 2011 Wiley-Liss, Inc.