الفهرس 
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Abstract
Since its first introduction into clinical practice, vascularized fibular transfer has gained an increasing popularity in reconstruction of segmental bone defects especially after tumor resection. However, its use in lower limb reconstruction was associated with delayed restoration of weight-bearing and increased incidence of stress fractures.
This work evaluated the reconstructive, functional and oncological outcomes of two reconstructive methods using free vascularized fibular transfer for reconstruction of skeletal defects following tumor resection around the knee in 69 patients. In the knee arthrodesis group includes 44 patients (mean age; 22.6 years) with minimal follow up of 12 month, 31 patients were males and 13 were females. The tumor involved the distal femur in 20 patients and the proximal tibia in 24 patients. Thirty-three tumors were malignant. All limbs were reconstructed by transfer of free vascularized fibula flap. The mean length of the reconstructed bone defect was 16.4 cm. Forty (90.9%) flaps survived the transplantation. The overall graft union rate was 100%, within a period averaged 4.35 months. Unprotected weight-bearing function could be achieved after a mean period of 7.1 months from the index operation. Graft fracture occurred in ten patients. All healed with conservative treatment and resulted in increased graft hypertrophy. Five donor-site related problems and 27 local complications were encountered in the 44 patients. Significant graft hypertrophy could be detected in 89% of patients after an average period of 12 months from the index operation. The average total score of these patients was 24.2 points. At the end of the study, three local recurrences, fifteen distant metastases and twelve deaths occurred in these patients. The limb salvage rate was 88.6%. The fibula-allograft group includes 25 patients (mean age; 19.7 years) with minimal follow up of 24 month. Sixteen patients were males and 9 were females. The tumor involved the distal femur in 4 patients and the proximal tibia in 21 patients. All the tumors were malignant. All limbs were reconstructed by microsurgical transfer of free vascularized fibula flap associated with massive allograft. The mean length of the reconstructed bone defect was 15.3 cm. Twenty-two (88%) flaps survived the transplantation. The overall fibula graft union rate was 100%, within average 5.6 months. The primary allograft union rate was 92%, which occurred within average 19.6 months. The fibula healed earlier with concentric assembly (p=0.042). Fixation of allograft with platting provided early union time of the allograft (p=0.013) than minimal fixation using screws and wires. There was significant correlation between the time of union of fibula and that of allograft (p=0.029). There was a negative significant correlation between the time of union of allograft and age of patient (p=0.046). Unprotected weight-bearing function could be achieved after a mean period of 21.4 months from the index operation. Fibular graft fracture occurred in three patients. All healed with conservative treatment and resulted in increased graft hypertrophy. Allograft fracture occurred 9 times in 7 patients. Six donor-site related problems and 17 local complications were encountered in the 25 patients. Significant graft hypertrophy could be detected in 90.5% of patients, at an average of 101.7 months. There was a positive significant correlation between the graft hypertrophy and time of union of allograft (p=0.025), time of full weight bearing (p=0.011) and occurrence of stress fractures (p=0.000). At the end of the study after a mean follow-up period of 140 months, the average total functional score of these patients was 27.4 points. At the end of the study, two local recurrences, three distant metastases and one death occurred in these patients. The overall limb salvage (Local recurrence + infection) rate was 88%.