Vascularized Fibular Epiphyseal Transfer for Pediatric Oncoplastic Reconstruction: Two Case Reports

Vascularized fibular epiphyseal transfer (VFET) has emerged as a reconstructive option for pediatric patients requiring limb salvage with preservation of growth potential. We presented 2 cases of VFET to the humerus following oncologic resection for osteosarcoma in children aged 11 and 5 years. Both cases demonstrated growth plate viability postoperatively, with serial imaging confirming annual growth rates of 0.8-1.2 cm/y. Despite successful bone growth, both patients developed persistent foot drop at donor sites requiring ankle-foot orthoses. We described our surgical technique, functional outcomes, and neurovascular complications. Additionally, we described a cost-effective growth monitoring method using a radio-opaque ruler, particularly valuable in resource-limited settings. This report contributes to the limited literature on VFET outcomes and highlights the need for improved techniques to mitigate donor site morbidity.