Dolph Houben

56 CHAPTER 3 Abstract Background: Reconstruction of segmental bone loss due to malignancy, infection or trauma is a challenging issue for the reconstructive surgeon. The combination of a vascularized fibula flap with a cortical allograft provides a reliable reconstructive option in the lower extremity. In this systematic review of literature, we describe the outcome of this technique for the treatment of segmental bone loss. Methods: A systematic review was performed on the use a combined massive allograft and intramedullary vascularized fibula as a reconstruction method for large bone defects. We used PubMed, EMBASE and Wiley Cochrane Library. No language restrictions were imposed. Results: 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. Main outcome measures were primary union, complication rate, re-intervention rate, and function after reconstruction. All publications show relatively high complication (5.9-85.7%) and re-intervention rates (10-91.7%) with good primary union rates (66.7-100%) and functional outcome (MSTS- score: 24-29). Conclusions: 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.