Long-term behavior of the vascularized fibular free flap for reconstruction of bony defects in children

Objective: Bony resection in children presents a unique reconstructive challenge because of future growth potential. To achieve limb salvage and provide the patient with a functional extremity, vascularized free fibula transfer has become the workhorse for bony reconstruction. The authors present their reconstructive experience using vascularized fibula flaps in a group of pediatric patients.

Patients and method: This is a monocentric, retrospective study of 25 pediatric patients who underwent reconstruction of bony defects with a vascularized fibula flap from 2004 to 2017. Perioperative and long-term complications were noted. Functional outcomes were analyzed.

Results: Twenty-five patients with a mean age of 10 years were included. The etiology was tumor for 21 of them and 4 had neurofibromatosis. Median follow-up was 86 months. Overall, survival was 92 percent and flap survival was 100 percent. Perioperative surgical complication rate was 32 percent. The overall union rate was 87 percent following supplemental bone grafting. 67 percent of the lower limb fibula presented hypertrophy, with a mean hypertrophy of 154 percent. Median time to union was 15 months. Leg-length discrepancy was present in 5 patients. Mean Musculoskeletal Tumor Score was 23.

Conclusion: Vascularized fibula free flap is the ideal material for long bone reconstruction with a definitive result. It allows children with early ambulation, provides good functional outcomes and improve their quality of life.