Vascularized Fibula-Based Physis Transfer: A Follow-Up Study of Longitudinal Bone Growth and Complications

Abstract

Background:The vascularized free fibula epiphyseal transfer provides an option for the preservation of limb lengthening after resection of the proximal humerus in pediatric sarcoma patients. The purpose of this study was to provide a long-term follow-up of longitudinal growth patterns and outcomes after free fibula epiphyseal transfer in upper extremity reconstruction.Methods:A retrospective review of 4 patients who underwent free fibula epiphyseal transfer after oncologic resection of the proximal humerus for osteosarcoma was performed. Oncologic details that could affect outcomes were included in the review: primary tumor pathology, location of malignancy, and presence of recurrence. Details on the reconstruction included longitudinal growth of the flap from the time of implantation to the most recently available radiograph and postoperative complications. The length of the fibula over time was measured from the humeral head to the olecranon process.Results:All patients were alive at the start of this study. The average longitudinal growth rate of the free fibula epiphyseal transfer was 0.54 ± 0.18 cm/y, and patients demonstrated satisfactory and consistent longitudinal bone growth and hypertrophy over time. All 4 patients suffered from a complication of postoperative fibula graft fracture, and 1 of 4 patients experienced unremitting peroneal nerve damage. All patients demonstrated normal wrist and hand motion with a normal arc of elbow flexion and extension.Conclusion:This study demonstrates that the vascularized fibula epiphyseal transfer offers the ability to preserve longitudinal limb growth and hypertrophy throughout adolescence.

Outcomes following Free Fibula Physeal Transfer for Pediatric Proximal Humerus Reconstruction: An International Multi-Institutional Study

“…12 In a more recent study, Shammas et al reported an average longitudinal growth of 0.54 ± 0.18 cm/ year. 19 The presented study demonstrated an average growth of 0.83 cm/year, similar to what one would expect for normal UE growth in unaffected children. 20 Reasons to explain the variability in the growth of the extremity following transfer include age of the patient relative to skeletal maturity, sex, mechanical factors, hormonal factors, nutritional status, quality/quantity of the blood supply, socioeconomic environment and rehabilitation availability, and skeletal growth retardation because of systemic stress from adjuvant chemotherapy.…”

“…22 Therefore, it is considered the preferred pedicle for the free fibula physeal transfer. Unfortunately, peroneal nerve palsy has long been discussed as a potential negative complication of proximal epiphyseal transfers, 4,19 and is a direct result of skeletonization of nerve with the dissection of the anterior tibial vascular supply of the fibula. [23][24][25] Rates of peroneal nerve palsies following fibula epiphyseal transfer have ranged from 67% to 100%.…”

Outcome of segmental prosthesis reconstruction for diaphyseal bone tumors: a multi-center retrospective study

“…However, the optimal choice of reconstructive method remains controversial [1]. Alternative reconstruction methods include autografts [2, 3], allografts [4, 5], bone transport [6], inactivated bone replantation [7, 8], and segmental prostheses [9–12]. Autografts with fibula or ilium have good bone tissue compatibility, playing an important role in diaphyseal reconstruction, but are limited by autologous bone sources and cause bone defect at the source [1, 3].…”

Experience of Saving Limbs With Free Fibula Osteocutaneous Flaps

“…Composite reconstruction is a challenging task as it requires proper planning and execution. Many authors had used free fibula flap as their first choice for the reconstruction for mandible [2,3], maxilla [4,5], clavicle [6], upper limb and lower limb [7,8], epiphysial transfer [9], hand [10] and foot [11][12][13]. One recent study by Taylor et al who also reported the first free vascularized fibula for a lower limb trauma, discuss many uses of vascularized fibula with his 40 years of experience [11,14].…”