1462 Sarcoma of the Distal Fibula; Presentation of an Anatomical Reconstruction and Literature Review

Introduction Musculoskeletal tumours affecting the lower limb, and the distal fibula in particular, are rare. Substantial variation exists in both reconstructive techniques employed in their management and reported results; a consequence of their low incidence and the specific challenges presented by the location. Advances in imaging and neo-adjuvant chemotherapy have sparked a paradigm shift in the management of these cases. Where amputation was once the mainstay, limb salvage surgery is now a viable option and multiple techniques exist, but outcomes are poorly studied. Method We performed a literature review and report a three-patient case series. All three patients underwent our novel reconstruction technique, utilising a vascularised ipsilateral fibula graft. Results 102 patient cases of distal fibula resection were identified. 57 of these patients had malignant disease. Evidence that limb salvage surgery produces good functional outcomes for sarcoma patients is limited; 25% of patients with malignant disease were reported as having poor outcomes or disease progression. All three patients undergoing our novel reconstructive technique have had good functional and oncological outcomes. Conclusions This is the largest literature review of patients undergoing distal fibula resection. Reconstruction is complex and no single solution exists. We present the use of a vascular proximal ipsilateral fibula graft, which to the best of our knowledge, has not been previously reported. The reconstructive method we present appears to be a durable technique offering an excellent functional outcome and is an appealing alternative to arthrodesis or amputation in appropriate patients.