[Reconstruction of primary malignant bone tumors in children: Do we really need to change our methods?]

Primary bone tumors in children are almost exclusively represented by osteosarcomas and Ewing sarcomas. They mainly affect the limbs, particularly the lower limbs. It is estimated that there are approximately 250 new cases per year. While the initial goal is survival, the question of reconstruction quickly follows. The aim of reconstruction is to avoid amputation, ensure functional outcomes, and, if possible, support ongoing growth in these children. For a long time, free fibula transfer was the first choice, as it allowed for the use of a vascularized bone whose shape was well-suited for limb reconstruction. Later, the induced membrane technique, also known as the Masquelet technique, was introduced. New radiotherapy protocols led to a preference for this latter technique. One of the arguments was that the risk of nonunion or delayed union would be too high with fibula grafts. So much so that, in our experience, no free fibula transfers were performed between 2015 and 2020. However, the analysis of the data from our series shows quite the opposite and does not support the superiority of the Masquelet technique (quite the contrary). Moreover, the fibula remains irreplaceable in certain indications (joint reconstruction, growth plate reconstruction, bi- or trifoliate graft reconstruction, etc.). Therefore, based on the analysis of our experience, the free fibula graft does not appear to be inferior in the specific context of bone reconstruction in children following malignant tumor resection.