Proximal Fibula Flap for Upper Extremity Reconstruction in Pediatric Patients: A Multicentric Study.

Area of Science:

• Orthopedic Surgery
• Pediatric Oncology
• Reconstructive Surgery

Background:

• Upper limb reconstruction after sarcoma resection is challenging, especially in pediatric patients requiring limb length matching for growth.
• Vascularized proximal fibula free flaps with physis based on anterior tibial vessels offer a potential solution.

Purpose of the Study:

• To evaluate the efficacy of vascularized proximal fibula free flaps for functional upper limb reconstruction in pediatric patients following oncologic resection.
• To assess outcomes including bone length increase, bony union, flap survival, and donor site morbidity.

Main Methods:

• Retrospective analysis of 14 pediatric patients undergoing vascularized proximal fibula flap transfer for humerus reconstruction.
• Preoperative and postoperative evaluation of bone length, bony union, flap survival, and donor site complications.
• Follow-up assessment of functional outcomes and complications such as nerve palsy or knee instability.

Main Results:

• 14 pediatric patients (average age 9.0 ± 2.4 years) with average humerus defect of 14.4 ± 2.3 cm were included.
• 100% flap survival rate with complete bone union and measurable bone length increase.
• No wound healing issues, knee instability, or significant donor site morbidity; one case of transient peroneal nerve palsy.

Conclusions:

• Vascularized proximal fibula free flaps provide immediate limb length restoration and enable long-term growth in pediatric upper limb reconstructions.
• This technique demonstrates high success rates with minimal donor site morbidity, making it a viable option for complex cases.