Comparing Insetting Techniques When Using the Vascularized Fibula Flap for Extremity Oncologic Defect Reconstruction in the Pediatric Population.

BACKGROUND

Extremity reconstruction in skeletally immature patients presents unique challenges in terms of operative technique, bone healing, and limb function. A variety of insetting techniques have been described, with no clearly superior option. We hypothesized that vascularized fibula flaps placed in the intramedullary space are associated with shorter union times and better functionality compared to onlay flaps.

METHODS

In a cohort study, we retrospectively reviewed the medical records of all pediatric patients who underwent fibula flap extremity reconstruction at a single center from 2001 through 2018. Patient comorbidities, complications, and outcomes were analyzed. Complete fibula union was based on radiographic evidence of significant cortical bridging.

RESULTS

Thirty-three patients with a mean age of 13.6 years (range, 2-18 years) underwent pedicled (n=7) or free (n=26) fibula flap reconstructions in 12 upper extremities and 21 lower extremities. Median follow-up was 69.5 months (IQR: 16.3-114.6). Onlay and intramedullary fibula position compared to intercalary placement (median 13.5 and 14.6 vs. 3.4 months, p=0.002) were associated with longer time to complete bone union. Complications including allograft fracture (p=0.02) and hardware removal (p=0.018) were also associated with longer time to complete union and eventual conversion to megaprothesis (p=0.02, p=0.038). Thirty-two patients (97%) achieved full union and a functional reconstruction.

CONCLUSIONS

Fibula flap reconstruction is safe and effective for pediatric long bone reconstruction. Longer fibula union times were associated with onlay and intramedullary fibula placement, allograft fracture, and hardware removal.

Informations de copyright

Copyright © 2023 by the American Society of Plastic Surgeons.