Limb salvage in proximal humerus malignant tumors: the place of free vascularized fibular graft.

Limb-salvage surgery has become a safe and well-established alternative to amputations for malignant tumors of the proximal humerus. The authors describe six cases with favorable restoration of the upper limb following tumor resection type IB Malawer and proximal humeral reconstruction by vascularized fibula graft (VFG) as a primary or secondary procedure. A scapulofibular arthrodesis was elected in all cases. A special custom-made plate was used in four cases. One patient required a latissimus dorsi musculocutaneous flap for better coverage. Serial x-rays assessed the bone union. Neither flap necrosis nor sepsis phenomena were noted. Stress fracture was the only complication. This was encountered in two cases. Every patient was reviewed and assessed by the Enneking score. The average score was 21.8. The average follow-up was 5-years. A good quality of life was preserved due to reliable mobility of the elbow and the hand.