Utility of free vascularized fibular flaps to treat radiation-associated nonunions in the upper extremity

Matthew R. Claxton, Matthew T. Houdek, Meagan E. Tibbo, Eric R. Wagner, Karim Bakri, Steven L. Moran

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Nonunion is a common complication following a fracture in the setting of previous radiotherapy; however, currently there is a paucity of data describing treatment for these nonunions in the upper extremity. Free vascularized fibular (FVF) flaps successfully treat bone defects; however, their efficacy with respect to treatment of radiated nonunions is limited. The purpose of the study was to assess the outcome following FVF for radiation-associated upper extremity nonunions. Methods: Seven patients underwent FVF for the treatment of radiation-associated upper extremity nonunion between 1998 and 2016. Results: There were 5 male and 2 female patients, with a mean age and follow-up of 44 years and 4 years, respectively. Mean total radiation dose was 41.3 Gy, given at a mean of 11 years prior to FVF. The average FVF length was 15 cm. First time union rate was 71%, however, following repeat bone grafting all patients healed. The median time to union was 10 months. Musculoskeletal Tumor Society scores improved from 57% preoperatively to 89% at latest follow-up (p < 0.0001). Conclusions: FVF is a reliable treatment option for radiation-associated nonunions of the upper extremity, providing an overall union rate of 100% and an improvement in functional outcome.

Original languageEnglish (US)
Pages (from-to)633-637
Number of pages5
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Issue number4
StatePublished - Apr 2020


  • Free vascularized fibula flap
  • Nonunion
  • Radiotherapy
  • Upper extremity

ASJC Scopus subject areas

  • Surgery


Dive into the research topics of 'Utility of free vascularized fibular flaps to treat radiation-associated nonunions in the upper extremity'. Together they form a unique fingerprint.

Cite this