Vascularized Rib Flap for Oncologic Spinal Reconstruction: TwoPatient Case Series and Narrative Review

Vascularized bone flaps serve as an important adjunct for achieving spinal stabilization after oncologic spinal reconstruction. Two cases involving vascularized rib flaps following tumor resection were retrospectively reviewed. Patient 1 was a 48-year-old man with prior chondrosarcoma resection who developed progressive deformity and hardware failure ten years postoperatively. Revision posterior spinal instrumentation was augmented with a 15 cm pedicled rib flap, one of the longest reported in the literature, spanning the thoracolumbar junction, resulting in stable alignment and radiographic incorporation at early follow-up. Patient 2 was a 68-year-old man with an irradiated L2 chordoma requiring en bloc spondylectomy and immediate anterior column reconstruction. A pedicled rib flap harvested through a lateral approach was used along with an expandable interbody cage, demonstrating durable fusion and stable alignment at four-year follow-up. Both patients remain free of recurrence and demonstrate durable spinal stability. A vascularized rib flap may be a feasible option for patients with multilevel posterior spinal column defects, including those with prior radiation. This approach is also advantageous in situations where microsurgical reconstruction or intraoperative repositioning is undesirable.