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Free Fibula Growth Plate Transfer After Bone Tumor Resection in Upper Extremities of Children
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ABSTRACT
Limb salvage surgery is the standard care for most malignant tumors affecting extremities, and a vascularized fibula transfer is probably the most popular microsurgical option to reconstruct long-bone defects. In the past 10 years, .80 patients underwent surgical treatment of bone tumor and primary microvascular reconstruction in a limb salvage treatment concept.
Skeletal reconstruction after bone tumor resection involving the metaphysis of a growing child can be successfully achieved with a vascularized fibula graft incorporating the proximal epiphysis and active growth plate. Successful transfer of the epiphysis requires modification of harvested fibula flap pedicle to include the anterior tibial artery. Such a procedure has been used in 3 children aged <11 years who had malignant bone tumors located in the upper limb, two in the distal radius and one in the proximal humerus.
Two patients underwent distal radius resection for treatment of osteosarcoma, one patients was treated for Ewing’s sarcoma of the proximal humerus. The mean bone defect was 11.8 cm. All grafts were supplied by the anterior tibial artery. Anastomosis of the tibial artery was performed in two patients in a retrograde fashion to provide pedicle length. In two patients, nerve grafting, tendon transfers, or both were performed. The wrist was stabilized with the remaining lateral collateral ligament and cast immobilization for 6 weeks. Mean follow-up was 16 months.
The average growth rate of the grafts has been >1 cm/year. Radiographic examination showed a subluxation of the wrist in one patient. The growth plate is open radiographically in all three patients. Growth plate transfer for reconstruction of the distal radius or proximal humerus can be accomplished using the fibula and fibular head. Vascular supply in this case is supplied by the anterior tibial artery. This procedure offers a satisfactory skeletal reconstruction and prevents future limb-size discrepancy.