• Rudolph H Houben, Mathijs Rots, Stefanie C M van den Heuvel, and WintersHenri A HHAHVU Medisch Centrum, Amsterdam, the Netherlands..
• VU Medisch Centrum, Amsterdam, the Netherlands.
• JBJS Rev. 2019 Aug 1; 7 (8): e2.

BackgroundReconstruction 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.MethodsA 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.ResultsSeventeen 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).ConclusionsThe 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.Level Of EvidenceTherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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