Reconstruction of long bones with vascularized fibula after resection of sarcoma in the children
Michel GERMAIN | Jean DUBOUSSET
Seance of wednesday 29 may 2024 (Communications Libres mai 2024)
DOI number : 10.26299/s3gm-b642/emem.2024.18.01
Abstract
Patients:
Limb salvage surgery is the standard care for most malignant tumors affecting the extremities in the child. Vascularized fibula transfer is the most microsurgical option to reconstruct long-bone defects. During twenty years, eighty two children with intractable sarcomas of the limbs were treated using vascularized fibula grafts. There were boys (n=54) and girls (n=28). Age: 4 to 17 years (mean=11). The reconstructed sites were the humerus (=16), radius (n=9) femur (n=44) tibia (n=13). After the resection of the sarcoma, the length of the bone defect ranged from 12 to 35 cm (mean: 22 cm). Etiology was: osteo sarcoma n=54, sarcoma of Ewing n=27. One child receive reconstruction with a U shaped vascularized fibular transplant.
Results. No post-operative death.
One local recurrence necessitated amputation of the limb. Benign complications were numerous especially for the femur: fracture of the grafted fibula, necessity of additional bone grafts, malunion (delayed consolidation) needed reoperation, pseudo arthrosis, ankle valgus, radial inclination necessitated reoperation. The mean period required to obtain radiographic bone union was 5 months. The functional results of the patients were evaluated according to the scale of Enneking. The results in our série ranged from 21 to 30 points. These results are regard to pain, emotional acceptance, manual dexterity.
The vascularized fibula grafts are indicated specially in children with long bone defects more than 8 cm. The future will be probably vascularized fibular graft associated with stem cells and matrix.
Limb salvage surgery is the standard care for most malignant tumors affecting the extremities in the child. Vascularized fibula transfer is the most microsurgical option to reconstruct long-bone defects. During twenty years, eighty two children with intractable sarcomas of the limbs were treated using vascularized fibula grafts. There were boys (n=54) and girls (n=28). Age: 4 to 17 years (mean=11). The reconstructed sites were the humerus (=16), radius (n=9) femur (n=44) tibia (n=13). After the resection of the sarcoma, the length of the bone defect ranged from 12 to 35 cm (mean: 22 cm). Etiology was: osteo sarcoma n=54, sarcoma of Ewing n=27. One child receive reconstruction with a U shaped vascularized fibular transplant.
Results. No post-operative death.
One local recurrence necessitated amputation of the limb. Benign complications were numerous especially for the femur: fracture of the grafted fibula, necessity of additional bone grafts, malunion (delayed consolidation) needed reoperation, pseudo arthrosis, ankle valgus, radial inclination necessitated reoperation. The mean period required to obtain radiographic bone union was 5 months. The functional results of the patients were evaluated according to the scale of Enneking. The results in our série ranged from 21 to 30 points. These results are regard to pain, emotional acceptance, manual dexterity.
The vascularized fibula grafts are indicated specially in children with long bone defects more than 8 cm. The future will be probably vascularized fibular graft associated with stem cells and matrix.