The use of the fibula flap in post oncologic reconstruction of long bone in pediatric patients: A retrospective cohort study.
BACKGROUND
Pediatric sarcomas are the most common malignancies of bones in childhood. With advances in adjuvant treatment, limb salvage surgery has become common, increasing the demand of skeletal reconstruction. Traditional practice included bone grafting and transport. Recently, microsurgical tissue transfer in pediatric patients has become a well-accepted practice, with the fibula as an ideal biologic construct for long bone reconstruction. We aim to assess the success rate of this operation, including flap survival, bony union, weight-bearing ambulation, and complications.


METHODS
We identified 10 pediatric patients who underwent reconstruction of long bones (femur, humerus, or tibia) with a free fibula flap from January 2015 to January 2020. All patients received neoadjuvant chemotherapy 4 weeks prior to the surgical procedure followed by adjuvant chemotherapy.


RESULTS
The average follow-up time was 15 months. We had no partial or total flap loss. Three of our patients passed away in the first post-operative year due to metastatic disease. In the remaining 7 patients, we had two long-term complications. The fibula of one patient did not exhibit hypertrophy, yet weight-bearing ambulation was achieved. The other patient had nonunion proximally that required bone grafting at 8 months post-operatively. After that, the same patient fractured her fibula and required surgical fixation. She was eventually able to achieve weight-bearing ambulation.


CONCLUSION
The vascularized fibula flap is a reliable tool for reconstruction in children. Flap survival is similar to that of adults. Complication rate is low compared to that for other forms of reconstruction.
['Karami|Reem A|RA|', 'Ghieh|Fadi M|FM|', 'Saghieh|Said S|SS|', 'Ibrahim|Amir E|AE|']
D000970:Antineoplastic Agents D001859:Bone Neoplasms D016025:Bone Transplantation D002648:Child D005121:Extremities D005260:Female D005360:Fibula D058752:Free Tissue Flaps D006801:Humans D007861:Lebanon D023821:Limb Salvage D000069451:Long Term Adverse Effects D008297:Male D012516:Osteosarcoma D010043:Outcome and Process Assessment, Health Care D010372:Pediatrics D011183:Postoperative Complications D019651:Reconstructive Surgical Procedures D012512:Sarcoma, Ewing
Pediatric sarcoma Long bone reconstruction Free fibula flap Microsurgery Pediatric microsurgery