随着化疗和手术技术的进步，以及腿肢保肢和生物重建（包括自体骨移植）的方式，已成为治疗肢体原发性恶性骨肿瘤的首选方法。尽管涉及到对患有肿瘤的骨骼进行回收的自体移植有易于获得和解剖匹配等优点，但骨折是常见的主要并发症。然而据我们所知，迄今尚未报道过难治性自体移植失败的保肢方法。本报告描述了用游离血管化腓骨移植来挽救治疗失败的先前重建方法。我们描述了两例患有原发性恶性骨肿瘤的患者（其中一位是4岁的女孩，另一位是30岁的男子）。在这两种情况下，液氮处理过的自体移植物被用于重建肱骨。这些患者发生了无法保守或内固定治疗的自体移植物骨折。游离血管化腓骨移植物被作为双筒入状骨移植物（长度分别为7.2和8.2厘米）和单支外形骨移植物（长度为16厘米）植入。肱动脉、肱静脉和桡静脉被用作受体血管。在分别经过29个月和15个月的随访后，腓骨移植物与肱骨之间实现了骨愈合。总而言之，游离血管化腓骨移植物可用于挽救难治性自体移植物骨折。版权所有2023年作者。 由 Wolters Kluwer Health 公司代表美国整形外科医师协会发布。

With advances in chemotherapy and surgical techniques, limb salvage and biological reconstruction, including autologous bone grafting, have become the preferred treatment options for primary malignant bone tumors of the extremities. Although autografts, which involve recycling of tumor-bearing bones, have the advantages of easy accessibility and anatomical matching, fracture is a frequent major complication. However, to our knowledge, salvage of refractory autograft failure has not yet been reported. This report describes free vascularized fibular graft implantation for salvaging failed previous reconstructions. We describe two patients (a 4-year-old girl and a 30-year-old man, respectively) with primary malignant bone tumors. Liquid nitrogen-treated autografts had been used to reconstruct the humerus in both cases. The patients sustained autograft fractures that could not be treated conservatively or by internal fixation. Free vascularized fibular grafts were transferred as double-barrel inlay grafts (length 7.2 and 8.2 cm) and a single-strut onlay graft (length 16 cm). The brachial arteries, brachial veins, and cephalic veins were used as recipient vessels. Bone union between the fibular grafts and humerus was achieved after 29 and 15 months of follow-up, respectively. In conclusion, free vascularized fibular grafts can be used to salvage refractory autograft fractures.Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.