(A400) A Case of Thoracic Mucor Requiring Transthoracic T2-4 Corpectomies with Fibula Free Flap Reconstruction

Introduction: Patients requiring resection of multiple vertebral bodies often experience high failure rates due to non-union; however, vascularized fibular grafts have demonstrated lower rates of non-union, particularly in the cervicothoracic region. Previously reported cases primarily focus on treatment of spinal neoplasms and highlight the unique challenges associated with vessel anastomosis in the thoracic region.

Methods: This case report describes the use of a fibula free flap as a reconstructive option for thoracic corpectomies in a unique case of multidrug-resistant mucormycosis.

Results: This is a case report of a 48-year-old male with b-cell acute lymphoblastic leukemia, undergoing chemotherapy, who presented with multidrug-resistant mucormycosis infection of the right upper lobe and thoracic spine. After failed medical and surgical management, and the need for source control, he underwent a three-staged approach for T2-4 mucormycosis osteonecrosis. This was a multidisciplinary transthoracic approach for T2-4 corpectomies requiring thoracic surgery, neurosurgery, and otolaryngology-head and neck surgery teams. Adequate exposure of the spine through a transthoracic approach also allowed for exposure of the upper thoracic cage. After removal of the diseased vertebral bodies, a fibula free flap was anastomosed with the traverse cervical artery. The vessels were passed into the neck between the clavicle and first rib with more than sufficient length for the vascular pedicle. The fibula was fit into the defect and a plate was placed spanning the T1-5 defect. The patient tolerated the procedure well and graft viability was monitored in the acute post-operative period without signs of flap failure.

Conclusions: Vascularized fibula free flaps are a potential reconstructive option for infections of the thoracic spine and require a multidisciplinary approach for safe and effective placement of the graft.