First Metatarsal Reconstruction After Resection for Musculoskeletal Tumors: A Technical Tip Using Vascularized Fibula

The foot represents a very rare site of primary bone and soft tissue tumors, accounting for less than 1% of all sarcomas; the forefoot is a relatively common site among foot sarcomas. The first metatarsal plays a crucial role in load bearing and gait, making its reconstruction crucial after tumor resection. Several reconstructive options have been described, including massive allografts, iliac crest autografts, and vascularized fibular grafts (VFGs). VFG offers biological advantages compared with nonvascularized reconstructions, such as earlier union, remodeling, and hypertrophy under mechanical stress—although union typically requires several months and hypertrophy up to a year—even after adjuvant therapies; furthermore, considering metatarsal reconstructions, VFG has a similar shape and diameter of the host bone. The aim of this work is to describe our technique for the reconstruction of the first metatarsal with VFG after resection for bone and soft tissue sarcoma, reporting its complication rate and functional result, and discussing their advantages and drawbacks in the long term.