TITLE:
Is It Safe to Harvest a Large Segment of the Fibula as Part of Lower Extremity Limb Salvage: A Pilot Study to Determine Safety and Functional Outcomes in 5 Patients
AUTHORS:
Woo Young Chun, Tilak Patel, Glod Douglas
KEYWORDS:
Fibula, Autograft, Strut, Limb Salvage, Reconstruction
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.15 No.11,
November
19,
2025
ABSTRACT: Purpose: While fibular autografts have been increasingly utilized for limb-salvage reconstruction, the safety of harvesting a large fibular segment for lower extremity reconstruction remains unreported. This pilot study evaluates pain, donor-site morbidity, functional outcomes, and patient satisfaction following ipsilateral fibular strut autograft limb salvage reconstruction. Method: Five patients (mean age 55 years) underwent ipsilateral fibular strut autograft lower extremity limb salvage reconstruction by a single foot and ankle surgeon. Patients who had at least 14 months of follow-up were systematically selected and retrospectively reviewed. The mean harvested fibular length was 15 cm. Fibular segments were assembled in a “railroad” configuration, using 7 struts for TTC fusion and 2 - 3 struts for medial column reconstruction. Standardized four questionnaires, adapted from the AOFAS Ankle/Hindfoot scoring scale, were used to assess postoperative pain, function, donor-site morbidity, and satisfaction. Results: At final follow-up, no patient reported donor-site pain, weakness, or functional limitation. Three (60%) returned to normal activity, and two (40%) had “some difficulty” with ambulation; all showed improved gait. Four (80%) were satisfied with outcomes, and one was neutral. VAS pain scores ranged 0 - 3/10 in all cases. All patients achieved successful limb salvage and avoided major amputation. Conclusion: Harvesting a large ipsilateral fibular autograft (average 15 cm) for lower extremity limb-salvage reconstruction appears safe and does not compromise post-operative functional outcome.