Free Vascularized Growth‐Plate Transfer after Bone Tumor Resection in Children

Abstract

Limb-salvage surgery is the standard care for most malignant tumors affecting the extremities, and a vascularized fibula transfer is probably the most popular microsurgical option to reconstruct long-bone defects. Skeletal reconstruction after bone-tumor resection involving the metepiphysis of a growing child can be successfully achieved with a vascularized fibula graft incorporating the proximal physis and active growth plate. Such a procedure has been utilized in 12 children under the age of 10 years who had malignant bone tumors located in the upper limb (3 in the distal radius, 9 in the proximal humerus). The follow-up ranged between 4 years and 3 months. Ten grafts were supplied by the anterior tibial artery, and two by the peroneal artery. The average growth rate of the grafts based on the former artery has been more than 1 cm per year, ranging between 0.75 and 1.33 cm. The authors describe a modified operative technique and discuss the clinical results of the procedure which offers a satisfactory skeletal reconstruction and prevents future limb-size discrepancy.

Free vascularized fibular grafting for reconstruction after tumor resection in the upper extremity

“…Reconstruction of the epiphysis is possible because of the plasticity of viable bone [61] which may permit remodeling of the fibular head into a spherical shape after grafting. This produces a good functional outcome after defect reconstruction of the proximal humerus [60]. VFG therefore offers a potentially satisfactory method of limb salvage after resection of large tumors of epiphyseal defects.…”

“…There are only a few described cases of epiphyseal defect reconstruction using VFG with fibular head transplantation, which leads to an age-depended longitudinal graft growth in skeletal immature patients [45,47,59,60]. In three cases in this study, we resected tumors of the proximal humerus (Cases 14, 15, and 16).…”

Vascularized fibula transfer for lower limb reconstruction

“…9 Utilizing proximal vascularized fibular graft, proximal humerus and distal radius defects have been reconstructed successfully. 10,11 Until now, only one case of successful reconstruction of the proximal femur following resection of Ewing's sarcoma has been described. 12 Tridimensional growth of the transplanted fibular head inside the acetabulum and sufficient functional outcome were reported 4 years after surgery.…”

The current role of the vascularized‐fibular osteocutaneous graft in the treatment of segmental defects of the upper extremity

“…These approaches have been associated with a fracture rate ranging from 0 to 40%. 9,[22][23][24][25][26] In addition, there have been several described cases of epiphyseal defect reconstruction for the proximal humerus and radius in young children [27][28][29][30] in attempts to avoid longitudinal skeletal discrepancies (Fig. 2).…”