Revisit ‘extracorporeal loop’ technique in free-tissue transfer

Reconstruction of a massive femoral bone defect using a double-barreled free vascularized fibular bone graft after wide resection of femoral chondrosarcoma

Salvaging the limb after malignant bone tumor ablation is a tough challenge for a reconstructive surgeon confronting such extensive bone defects. A 40-year-old male without any underlying disease was incidentally diagnosed with a chondrosarcoma over his left femoral bone. An orthopedic surgeon did a wide resection of the malignant bone tumor, leaving a massive bone defect about 11.3 cm in length. A double-barreled free vascularized fibular bone was designed to reconstruct the femoral bone defect. The maximal fibular bone graft harvested was 19 cm long; after the osteotomy, one barrel was 11 cm and the other was 8 cm. An iliac crest cancellous bone graft was harvested to fill the residual space. The pathology report showed a grade 1 well-differentiated conventional chondrosarcoma, and further adjuvant therapy was not suggested. At a 3-year follow-up, plain radiography showed a good bony union of the graft, and the patient could easily tolerate daily activity. A vascularized double-barreled fibular graft is an ideal option for reconstructing a massive defect in weight-bearing bone: it provides not only sufficient mechanical strength but also good union for early rehabilitation. We describe the long-term results after reconstruction and provide a literature review of long-bone chondrosarcoma.