Ipsilateral Nonvascularized Autograft and Periosteal Repair for the Treatment of Pediatric Tumors of the Distal Fibula

Abstract

Resection of the distal fibula is used to treat malignant or benign locally aggressive tumors involving this region. Current reconstructive techniques are limited by undesirable functional deficits. The authors present a part-retrospective and part-prospective case-comparison of 2 patient groups (study and control) treated for malignant or benign locally aggressive primary bone tumors of the distal fibula. Patients in the study group underwent a novel surgical technique involving distal transportation of the ipsilateral proximal portion of the fibula after periosteal dissection and osteotomy with subsequent proximal periosteal reconstruction. Patients in the control group underwent other limb-salvage or amputation procedures. Patients were evaluated at follow-up appointments for oncologic, radiographic, and functional outcomes. The groups had similar demographic and perioperative data. Operative time was longer in the study group. Radiographic union occurred in 75% of the study group vs 50% of the control group. Musculoskeletal Tumor Society scores were similar between groups. According to American Foot and Ankle scores, activity limitations and support requirements were greater in the study group; according to Foot and Ankle Disability Index scores, patients in the control group reported more difficulty with squatting. All patients in the study group were without recurrence at follow-up. One patient in the control group had recurrence of disease. Complications occurred in 3 of 4 study group patients and in all control group patients. With the authors' technique for distal fibular reconstruction involving transporting the ipsilateral remaining proximal fibula as a nonvascularized autograft, the regenerative capability of the periosteum allows for restoration of the proximal fibula, preserving osseous stock. [Orthopedics. 2016; 39(4):e687-e694.].

Pedicled Retrograde Fibula Flap for Ankle Reconstruction after Oncologic Resection of the Distal Fibula

“…1 Ankle reconstruction for defects involving the distal fibula include arthrodesis, nonvascularized autografts, and free flaps. 2 Pedicled flaps have some advantages over free flaps, including decreased operative time and decreased postoperative complications. 3 Pedicled retrograde fibula flaps have been previously described for tibial reconstruction, but to our knowledge, the use of a pedicled retrograde fibula graft based on the peroneal artery to achieve ankle joint stability after resection of the distal fibula has not yet been reported.…”