Vascularized proximal fibula epiphyseal transfer for distal radius reconstruction in children: A systematic review

Aldekhayel, Salah; Govshievich, Alexander; Neel, Omar Fouda; Luc, Mario

doi:10.1002/micr.22521

Cited by 21 publications

(11 citation statements)

References 30 publications

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“…The frequency of this injury is due to the proximity of the peroneal nerve to the anterior tibial vascular supply of the fibula head, making isolation and protection of this nerve difficult. 18,22,23 Caution must be taken to isolate and protect this nerve during fibula dissection. Some surgeons advocate for dividing branches of the peroneal nerve at the musculature and performing coaptation after fibula harvest.…”

Section: Discussionmentioning

confidence: 99%

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

Shammas

Avashia

Farjat

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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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.

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Section: Discussionmentioning

confidence: 99%

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

Shammas

Avashia

Farjat

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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“…The common complications in the radius reconstruction are radial deviation and wrist subluxation, which often necessitate second surgery to correct or stabilize. Salah [50] reviewed 25 patients who underwent distal radius reconstruction, in which 16 patients developed recipient site complication, among which 4 patients had premature growth plate closure, 6 patient had radial deviation, and 4 patient had ulnar deviation or wrist subluxation.…”

Section: Proximal Fibular Epiphyseal Transfermentioning

confidence: 99%

Complication of osteo reconstruction by utilizing free vascularized fibular bone graft

Zhou

et al. 2020

BMC Surg

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The success of free vascularized fibular bone graft (FVFBG) has accelerated the osteo reconstruction which results from trauma, resection of a tumor or an infectious bone segment, or correction of congenital deformity. But the complication behind should not be overlooked. The failure could necessitate a second surgery, which prolong the rehabilitation period and produce further health cost. Worst, the patients may suffer a permanent impaired ankle function, or a sustained morpho-functional loss on reconstructive area which are hard to save. To provide an overview of the complication related to reconstruction by FVFBG, a narrative review is conducted to identify the complications including their types and rates, the contributing factors, the approaches to measure and the techniques to avoid. Methodologically, by quick research on Pubmed and abstract reading of reviews, we characterize five reconstructive areas where FVFBG were most frequently applied: extremities, mandible, spine, osteonecrosis of femoral head, and penile. Following, the complications on different reconstructive areas are retrieved, studied and presented in five (or more specifically, six) separate sections. By the way, meaningful difference between FVFBG and other bone flap was presented in a few words if necessary. Donor-site morbidities were studied and summarized as a whole. In these literatures, the evidences documented on limb and mandibular reconstruction have the fullest detail, followed by the spine and lastly the penile. In conclusion, FVFBG, though a mature technique, needs further deep and comprehensive study and maybe device-based assistance to achieve better reconstructive effect and minimize donor-site damage.

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“…Our 44.8% overall complication rate is similar to that reported by other studies within the pediatric population (25-100%). 4,7,12,14,17,[20][21][22][23][24][25][26][27][29][30][31][32][33][34][35][36][37] One exception is our rate of neurologic injury (3.4%), which is much lower than other published reports. While most frequently seen as a donor-site complication, the single neurologic complication in our series was in the recipient site, where the patient experienced a deep peroneal nerve palsy secondary to postoperative swelling.…”

Section: Discussionmentioning

confidence: 91%

“…2,6,[9][10][11] Transfer of the proximal fibula with the epiphysis allows for biological joint reconstruction, and the active viable physis has the advantage of preserving longitudinal growth. [12][13][14] The vascularized graft is also particularly useful in cases where there is poor tissue quality of the reconstructive bed such as in posttraumatic scarring or following chemotherapy. 4,9,15 Large cohorts with extended follow-up are important for understanding the long-term impact of the procedure; however, the majority of the current literature has focused on the adult population.…”

mentioning

confidence: 99%

Surgical Outcomes, Complications, and Long-Term Functionality for Free Vascularized Fibula Grafts in the Pediatric Population: A 17-Year Experience and Systematic Review of the Literature

McCullough

Arkader

Ariani

et al. 2020

J Reconstr Microsurg

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Background In the pediatric population, bony defects of the extremities pose a significant challenge for which free vascularized fibular grafts (FVFGs) represent a valuable reconstructive option. The purpose of this study was to explore surgical outcomes, complications, and long-term functionality of FVFG for this patient group. Methods Using MEDLINE and PubMed databases, studies were identified of pediatric extremity reconstruction using FVFG which reported functional outcomes and/or complications. The operative logs at a tertiary pediatric center were then reviewed for cases of FVFG between January 2000 and 2017. Demographic characteristics, surgical indications, operative details, graft survival, bony union, complications, and functionality of the reconstruction were recorded. Results A total of 366 studies were identified with 23 ultimately meeting inclusion criteria in the systematic review. In the institutional series, 29 patients were included with mean age of 9.7 years (1–17 years). Indications for reconstruction included malignant bone tumor (n = 11), osteomyelitis (n = 9), congenital pseudoarthrosis (n = 6), and osteofibrous dysplasia (n = 3). Major postoperative complications included graft nonunion (24.1%), fracture (17.2%), and hardware failure (17.2%). Thirteen patients (44.8%) experienced delayed complications, while two (6.8%) experienced an immediate complication. Complications occurred in the donor site in 2 cases and the recipient site in all 13 cases. Long-term graft survival was achieved in 27 patients (93.1%), and 23 (79.3%) had full functional recovery, with an average Musculoskeletal Tumor Society score of 90% (60–100%). Mean follow-up was 5.17 years (2–12 years). Conclusion This review and institutional series demonstrate the versatility of FVFG to facilitate limb reconstruction in large defects or serve as a salvage option in complex cases. While immediate and donor-site complications are uncommon, delayed recipient-site complications are frequent, and patients and families should be counseled regarding this expectation. Though technically challenging, excellent long-term graft viability and functional recovery can be achieved in the large majority of patients.

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Vascularized proximal fibula epiphyseal transfer for distal radius reconstruction in children: A systematic review

Abstract: IV © 2015 Wiley Periodicals, Inc. Microsurgery 36:705-711, 2016.

Cited by 21 publications

References 30 publications

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

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

Complication of osteo reconstruction by utilizing free vascularized fibular bone graft

Surgical Outcomes, Complications, and Long-Term Functionality for Free Vascularized Fibula Grafts in the Pediatric Population: A 17-Year Experience and Systematic Review of the Literature

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