Free Fibular Flap for Clavicle Reconstruction: an Orthoplastic approach.

Abstract

Clavicular reconstruction poses several challenges to the reconstructive surgeons, especially when a long bone defect needs to be addressed. The aim of this paper is to present a European multicentre case series on the use of free fibula flap for clavicle reconstruction, reporting the outcomes in a uniform manner. The objective is also to apply orthoplastic concepts to suggest technical tips to maximise the success of the procedure. Adult patients affected by clavicular bone loss due to trauma, infection, or oncological resections, were included. Surgical outcomes were measured in terms of bone healing and functional recovery through pre-operative and post-operative Disability of Arm, Shoulder, and Hand (DASH) and Constant-Murley score. Complication rates were recorded. Patients were followed-up with radiographs obtained at 1,3,6,9 and 12 months. Nine patients with a mean age of 44.4 ±16.4yo were included. The mean clavicular bone defect was 8.5±2.8 cm. The etiologies of defect were sarcoma excision (5/9) fracture-related infection (2/9), osteoradionecrosis (1/9) and chronic sclerosing osteomyelitis of Garré (1/9). The average follow-up was 32.8±13.1 months. A successful bone union was achieved in all cases after 180±20 days. Significant improvements in both the DASH and Constant-Murley score were recorded. Orthoplastic principles were applied, such as dual plate fixation in a 90° configuration and use of minifragment plates. This study supports the fibular flap's efficacy in reconstructing critical-sized clavicular defects and emphasizes technical strategies to reach the stability of the final construct and optimize the functional outcome.