Femur–fibula–fillet of leg chimeric free flap for sacral-pelvic reconstruction

SummaryWe describe the first case of a femur free flap in which we utilized the femur to restore pelvic ring continuity following a combined external hemipelvectomy-sacrectomy for cancer. We feel that the femur flap can be an important reconstructive tool for load-bearing bony reconstruction of the pelvis and spine when lower extremity amputation is required. We also utilized a fibula flap to stabilize the spine and a fillet of leg flap to provide soft tissue coverage as part of a chimeric femur–fibula–fillet of leg free flap from the same limb, allowing us to reconstruct a large, complex defect with “spare parts” from the discarded lower extremity, thereby totally eliminating any donor site morbidity.