Total hip reconstruction after sarcoma resection in children with a free vascularized fibula without osteotomy of the bone flap: Technique description and case series

Lovic, A.; Ortiz‐Cruz, Eduardo J.; Pérez-Rodríguez, Javier; Bolado-Gutiérrez, Pedro; Manzanares-Retamosa, Maria Luisa

doi:10.1016/j.bjps.2022.04.074

Cited by 2 publications

(14 citation statements)

References 26 publications

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“…Oncologic indications most commonly included osteosarcoma and Ewing sarcoma. 2,3,5,6,[8][9][10][12][13][14][16][17][18][19]21,[23][24][25]27,[31][32][33][36][37][38]40 Congenital deformities included radial longitudinal deficiency and ulnar pseudarthrosis. 19,22,23,27,30,35 Traumatic injuries involved the lateral malleolus, calcaneus, radius, and ulna.…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 details the summary of VFET technique considerations extracted from these articles to help guide surgical planning. 2,3,5–42…”

Section: Resultsmentioning

confidence: 99%

“…The predominant method of fixation was the combined use of plates and screws. 9,[12][13][14]17,20,23,29,30,32,33,36,37,40 Although a plate bridging the flap may provide stable fixation to maintain postoperative alignment, there has been concern that it can interrupt the blood supply and prevent flap thickening over time. 29 Several cases therefore involved fixation with screws alone.…”

Section: Recipient Site Flap Insetmentioning

confidence: 99%

“…5,25,26 Following inset of VFET at the recipient site, muscle reattachment and soft tissue reconstruction were performed to support the reconstructed joint. 13,18,37 Examples of ligamentous reconstruction using the biceps femoral tendon included wrapping it around the coracoid process of the scapula or anchoring it to the glenoid capsule for shoulder stabilization, 3,10,14 weaving it into the residual capsule to stabilize the radiocarpal joint in distal radius and ulna reconstruction, 8,22,23 helping reconstruct calcaneal ligaments in ankle reconstruction, 15,20,31 and suturing it into the remaining capsular ligament of the TMJ in mandible reconstruction. 17 Postoperative protocols entailed immobilization followed by rehabilitation with progressive range of motion…”

Section: Recipient Site Flap Insetmentioning

confidence: 99%

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Vascularized Fibular Epiphyseal Transfer for Pediatric Limb Salvage: Review of Applications and Outcomes

Lee,

Tiourin,

Khoshab

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Summary: Vascularized fibular epiphyseal transfer (VFET) offers a functional advantage in pediatric limb salvage due to the preservation of growth potential and an articular surface for remodeling. This review summarizes the available evidence on the clinical characteristics and outcomes of pediatric reconstruction applying VFET at different recipient sites and with varying techniques. VFET was used to reconstruct the proximal humerus, distal radius or ulna, proximal femur, distal fibula, calcaneus, and mandible. Although most often harvested on the anterior tibial artery, VFET has also been performed using the peroneal artery, the inferior lateral genicular artery, and a dual pedicle. Recipient site flap inset most often involved fixation with plates and/or screws as well as soft tissue reconstruction using a retained slip of biceps femoris tendon. Outcomes included limb growth, range of motion, and strength. The most common reported complications were bone flap fracture and peroneal nerve palsy. The anterior tibial artery was the most applied pedicle with reliable limb growth, but with the added risk of postoperative peroneal palsy. Bone flap fracture most often occurred at the proximal humerus and femur recipient sites. Plate fixation and the combined use of allograft had lower instances of bone flap fracture. This review highlights how the anticipated dynamic growth and remodeling this free flap offers in the long term must be weighed against its complexity and potential complications.

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Section: Resultsmentioning

confidence: 99%

“…Table 1 details the summary of VFET technique considerations extracted from these articles to help guide surgical planning. 2,3,5–42…”

Section: Resultsmentioning

confidence: 99%

Section: Recipient Site Flap Insetmentioning

confidence: 99%

Section: Recipient Site Flap Insetmentioning

confidence: 99%

See 2 more Smart Citations

Vascularized Fibular Epiphyseal Transfer for Pediatric Limb Salvage: Review of Applications and Outcomes

Lee,

Tiourin,

Khoshab

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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“…10 Recently, Lovic et al reported on 3 children in whom the proximal femur was reconstructed after tumor resection using vascularized epiphyso-diaphyseal fibula flap inserted into radius allograft with encouraging functional results and no complications. 11 There has been only 1 report in the literature on proximal femur reconstruction using vascularized epiphyseal transfer following septic necrosis in 3 children, with poor functional results in 2 of them. 12 The current study is the largest reported series of hip reconstructions using vascularized epiphyseal transfer following septic necrosis of the femoral head and neck in children.…”

Section: Introductionmentioning

confidence: 99%

Free Vascularized Proximal Fibular Epiphyseal Transfer For Hip Reconstruction Following Septic Necrosis In Children

El-Gammal,

El-Sayed Ali,

Kotb

et al. 2024

Journal of Pediatric Orthopaedics

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Background: Septic necrosis of the femoral head and neck in children represents a challenging problem. Several reconstructive techniques have been described but with disappointing long-term results. Vascularized epiphyseal transfer utilizing the proximal fibula have been successfully used for reconstruction of the proximal humerus and distal radius and only scarcely used for hip reconstruction. This cohort represents the largest reported series of epiphyseal transfer for hip reconstruction following septic necrosis in children. Methods: A total of 18 patients with an average age at surgery of 5.4 years were included. The average follow-up was 3.6 years (range 2.3 to 6.8 y). Results: Transient postoperative foot drop was observed in 4 patients. Radiographic resorption of the transferred fibula occurred in 2 cases. Longitudinal growth averaged 7.3 mm/year, and the physis width increased by an average of 2.7 mm/year. The rate of longitudinal growth was fastest after the age of 10 years (18.5 mm/y), which coincides with the pubertal growth spurt. All successful transfers had an open growth plate on final follow-up radiographs. Ten patients had limb length discrepancy of an average 2.8 cm (range 1 to 8 cm). Thirteen patients had satisfactory functional according to the criteria of Hunka et al. Three patients had unsatisfactory results; one had painful nonunion at the fibula-femur junction, and the other two had limited flexion range of 45 degrees. The average postoperative neck-shaft angle was 96.4 degrees which decreased by an average of 8 degrees at the final follow-up. Three patients underwent a valgus subtrochanteric osteotomy to correct a severe varus deformity. The final neck-shaft angle correlated significantly with the functional results where it averaged 96 degrees in the satisfactory group and 57 degrees in the unsatisfactory group. Conclusion: Vascularized epiphyseal transfer presents a promising treatment for children with septic necrosis of the femoral head and neck in whom other methods have failed to provide satisfactory long-term results. We recommend the procedure be done before the age of 5 years for optimum results. Level of Evidence: Level—IV.

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Total hip reconstruction after sarcoma resection in children with a free vascularized fibula without osteotomy of the bone flap: Technique description and case series

Cited by 2 publications

References 26 publications

Vascularized Fibular Epiphyseal Transfer for Pediatric Limb Salvage: Review of Applications and Outcomes

Vascularized Fibular Epiphyseal Transfer for Pediatric Limb Salvage: Review of Applications and Outcomes

Free Vascularized Proximal Fibular Epiphyseal Transfer For Hip Reconstruction Following Septic Necrosis In Children

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