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Functional development of the donor leg after vascularized fibula graft in childhood
H Xijing1, L Haopeng, J Liaosha
1Orthopaedic Department, Second Teaching Hospital, Xi'an Medical University, People's Republic of China.
Insights
Free vascularized fibula grafts in children show no adverse effects on donor leg function. Donor leg muscle strength and range of motion remain comparable to the recipient leg, ensuring good functional development.
Area of Science:
- Orthopedic surgery
- Pediatric reconstructive surgery
- Microsurgery
Background:
- Free vascularized fibula grafts are used for limb reconstruction.
- Complications in adults undergoing fibula harvest are a concern.
- The effect on donor leg development in children is less understood.
Purpose of the Study:
- To evaluate the long-term functional outcomes of donor leg function after free vascularized fibula graft harvest in children.
- To assess potential complications and developmental effects on the donor leg.
Main Methods:
- A retrospective review of 30 children undergoing fibula harvest over 10 years.
- Anterolateral approach for fibula harvest with an average graft length of 6.0 cm.
- Average follow-up of 8 years, including functional and radiographic assessments.
Main Results:
- No vascular injury or shank dysplasia observed.
- Transient neural symptoms in 8 patients (resolving in 6).
- Comparable muscle strength and range of motion in donor ankles versus recipient legs; improved ankle stability with growth.
Conclusions:
- Free vascularized fibula graft harvest in children does not adversely affect donor leg functional development.
- The procedure appears safer in children compared to adults regarding donor leg complications.
- Long-term donor leg growth contributes to ankle stability.
Purpose:
To evaluate the effect of free vascularized fibula grafts on developing donor leg function, the authors reviewed their experience of procedures performed in children.
Methods:
Over a 10-year period, 30 children (average age 7.2 years, without gender concern) underwent fibula harvest via an anterolateral approach. Graft length averaged 6.0 cm. Follow-up averaged 8 years.
Results:
No vascular injury or shank dysplasia ensued. Neural injury occurred in 8 patients: to the profound peroneal nerve in 1 and to the superficial peroneal nerve in 7. Symptoms resolved spontaneously at 3 to 5 months in 6, but persisted in 2 patients in the latter group at 8 years' follow-up. Of 24 children who underwent rapid walking (200 m) followed by immediate stair climbing (50 steps), 2 (whose grafts were longer than average) had slight and 1 had obvious ankle pain. However, muscle strength and range of motion in the donor ankle were no different from values in the recipient leg in the 24 cases. X-ray findings showed that, with growth, the remaining 2 fibular segments in the donor leg became longer, but the length of the gap between did not change. Thus, the gap left by harvest became relatively shorter long after operation, benefiting the stability of the ankle joint in adulthood.
Conclusion:
Unlike free vascularized fibula grafts performed in adulthood, from which serious complications to the donor leg have been reported, the procedure performed in childhood appears not to have an adverse effect on functional development.