Use of the vascularized free fibula graft with an arteriovenous loop for fusion of cervical and thoracic spinal defects in previously irradiated pediatric XXXX .

@entity1 @entity18431 @entity5 @entity254 @entity85
BACKGROUND: Extensive @entity18431 are difficult to manage. Following resection, arthrodesis of the spine can be performed with instrumentation, but this often fails in the setting of radiation therapy. Use of the free fibula flap for anterior spinal fusion to @entity85 has been described in multiple studies, but its use for posterior spinal fusion has been limited. In addition, its use in the pediatric population for this purpose has not been reported. METHODS: A retrospective review was performed of three pediatric cases of cervical and thoracic spine @entity5 resection with posterior fusion of the spine with a microvascular fibula flap over a 2-year period. Data recorded included @entity1 demographics, medical/surgical history, indications for surgery, length of free fibula flap, recipient vessels, ischemic time, number of osteotomies performed on the fibula, complications, and time to computed tomography-documented fusion of the fibula to the remaining spinal column. RESULTS: All three microvascular anastomoses were successfully performed using an arteriovenous loop of saphenous vein graft to the anterior neck or subscapular vessels. The average length of fibula harvested was 23.7 cm, the average length of ischemic time was 220 minutes, the number of osteotomies in all cases was two, and there was bony fusion at an average of 15.7 weeks postoperatively. CONCLUSIONS: The free fibula flap is ideally suited for accelerated posterior spinal fusion after extensive resection of cervical or thoracic @entity18431 . An arteriovenous saphenous vein loop facilitates the microvascular @entity254 in this anatomical region that lacks suitable recipient vessels.
