Use of blood-supplied fibula grafts with a functioning growth zone for the reconstruction of limb bone defects in pediatric patients: A literature review

Abstract

 

BACKGROUND: Restoration of significant anatomical and functional bone defects is one of the most urgent problems of reconstructive surgery in children. Various options for plastic surgery of bone defects are considered. However, some publications present both positive and negative aspects of using vascularized bone autotransplants.

AIM: This study aimed to conduct a systematic analysis of foreign literature data on the use of blood-supplied fibular grafts with a functioning growth zone.

MATERIAL AND METHODS: A systematic literature search was performed in the PubMed information data base and Google Scholar from 1988 to February 7, 2021. Based on the criteria for the selection of literature sources, 21 literary sources were identified. In the analysis, special attention was paid to the age of patients at the time of reconstructive surgery, type of vascularized bone graft used with vessels that are part of the feeding leg, follow-up period, complications in the area of the surgical intervention, as well as the functional result and functioning of the graft growth zone.

RESULTS: In this study, 21 articles comprised the sample, of which 14 were descriptions of clinical observation and seven were descriptions of clinical series. These publications include information on the follow-up of 54 patients with an average age of 6.86 years (min–max, 1–15 years). The average duration of postoperative follow-up was 56 months (min–max, 6–22 years). Indications for surgical interventions were extensive bone defects formed as a result of the tumor process (n = 44), trauma (n = 4), infectious process (n = 1), and birth defects (n = 5).

CONCLUSIONS: In pediatric orthopedics, bone-vascularized fibular grafts with a functioning growth zone are used for the reconstruction of extensive bone defects in complex clinical situations if standard bone auto-/alloplasties are impossible. According to the literature, this technique allows us to achieve satisfactory functional results in most cases. Despite the positive functional results, postoperative complications are quite common in patients.

 

Keywords

pediatric / epiphyseal / vascularized fibula / epiphyseal transfer / fibular graft

References

[1] Shin E, Shin A. Vascularized bone grafts in orthopaedic surgery. JBJS Rev. 2017;5(10):85–99. DOI: 10.2106/jbjs.rvw.16.00125

[2] Shin E., Shin A. Vascularized bone grafts in orthopaedic surgery // JBJS Rev. 2017. Vol. 5. No. 10. P. 85–99. DOI: 10.2106/jbjs.rvw.16.00125

[3] Innocenti M, Delcroix L, Romano G, Capanna R. Vascularized epiphyseal transplant. Orthop Clin North Am. 2007;38(1):95–101. DOI: 10.1016/j.ocl.2006.10.003

[4] Innocenti M., Delcroix L., Romano G., Capanna R. Vascularized epiphyseal transplant // Orthop. Clin. North Am. 2007. Vol. 38. No. 1. P. 95–101. DOI: 10.1016/j.ocl.2006.10.003

[5] Sakai K, Doi K, Kawai S. Free vascularized thin corticoperiosteal graft. Plast Reconstr Surg. 1991;87(2):290–298. DOI: 10.1097/00006534-199102000-00011

[6] Sakai K., Doi K., Kawai S. Free vascularized thin corticoperiosteal graft // Plast. Reconstr. Surg. 1991. Vol. 87. No. 2. P. 290–298. DOI: 10.1097/00006534-199102000-00011

[7] Soldado F, Fontecha C, Barber I, et al. Vascularized fibular periosteal graft. J Ped Orthop. 2012;32(3):308–313. DOI: 10.1097/bpo.0b013e31824b2843

[8] Soldado F., Fontecha C., Barber I. et al. Vascularized fibular periosteal graft // J. Ped. Orthop. 2012. Vol. 32. No. 3. P. 308–313. DOI: 10.1097/bpo.0b013e31824b2843

[9] Hu W, Trimaille A, De Vries P, et al. Paediatric distal fibula reconstruction using a pedicled composite second metatarsal flap: A technical note. Injury. 2015;46(10):2055–2058. DOI: 10.1016/j.injury.2015.07.011

[10] Hu W., Trimaille A., De Vries P. et al. Paediatric distal fibula reconstruction using a pedicled composite second metatarsal flap: A technical note // Injury. 2015. Vol. 46. No. 10. P. 2055–2058. DOI: 10.1016/j.injury.2015.07.011

[11] Wood M, Gilbert A. Microvascular bone reconstruction. London: Dunitz; 1997.

[12] Wood M., Gilbert A. Microvascular bone reconstruction. London: Dunitz, 1997.

[13] Ad-El D, Paizer A, Pidhortz C. Bipedicled vascularized fibula flap for proximal humerus defect in a child. Plast Reconstr Surg. 2001;107(1):155–157. DOI: 10.1097/00006534-200101000-00024

[14] Ad-El D., Paizer A., Pidhortz C. Bipedicled vascularized fibula flap for proximal humerus defect in a child // Plast. Reconstr. Surg. 2001. Vol. 107. No. 1. P. 155–157. DOI: 10.1097/00006534-200101000-00024

[15] Akinbo O, Strauch R. Physeal transfers for skeletal reconstruction. J Hand Surg Am. 2008;33(4):584–590. DOI: 10.1016/j.jhsa.2007.12.023

[16] Akinbo O., Strauch R. Physeal transfers for skeletal reconstruction // J. Hand. Surg. Am. 2008. Vol. 33. No. 4. P. 584–590. DOI: 10.1016/j.jhsa.2007.12.023

[17] Cavadas P, Thione A. Reconstruction of the lateral malleolus in a type-Ib fibular hemimelia with a microvascular proximal fibular flap. J Pediatric Orthop B. 2015;24(4):370–372. DOI: 10.1097/bpb.0000000000000176

[18] Cavadas P., Thione A. Reconstruction of the lateral malleolus in a type-Ib fibular hemimelia with a microvascular proximal fibular flap // J. Pediatric Orthop. B. 2015. Vol. 24. No. 4. P. 370–372. DOI: 10.1097/bpb.0000000000000176

[19] Concannon M, Croll G, Boschert M, et al. Free fibular transfer in a growing individual (long-term results). Microsurgery. 1993;14(9):624–627. DOI: 10.1002/micr.1920140916

[20] Concannon M., Croll G., Boschert M. et al. Free fibular transfer in a growing individual (long-term results) // Microsurgery. 1993. Vol. 14. No. 9. P. 624–627. DOI: 10.1002/micr.1920140916

[21] Bibbo C, Ehrlich D, Kovach S. Reconstruction of the pediatric lateral malleolus and physis by free microvascular transfer of the proximal fibular physis. J Foot Ankle Surg. 2015;54(5):994–1000. DOI: 10.1053/j.jfas.2014.12.004

[22] Bibbo C., Ehrlich D., Kovach S. Reconstruction of the pediatric lateral malleolus and physis by free microvascular transfer of the proximal fibular physis // J. Foot Ankle Surg. 2015. Vol. 54. No. 5. P. 994–1000. DOI: 10.1053/j.jfas.2014.12.004

[23] De Gauzy J, Kany J, Cahuzac J. Distal fibular reconstruction with pedicled vascularized fibular head graft: A case report. J Pediatric Orthop B. 2002;11(2):176–180. DOI: 10.1097/01202412-200204000-00017

[24] De Gauzy J., Kany J., Cahuzac J. Distal fibular reconstruction with pedicled vascularized fibular head graft: A case report // J. Pediatric Orthop. B. 2002. Vol. 11. No. 2. P. 176–180. DOI: 10.1097/01202412-200204000-00017

[25] Erdmann D, Garcia R, Blueschke G, et al. Vascularized fibula-based physis transfer for pediatric proximal humerus reconstruction. Plast Reconstr Surg. 2013;132(2):281e–287e. DOI: 10.1097/prs.0b013e31829589fb

[26] Erdmann D., Garcia R., Blueschke G. et al. Vascularized fibula-based physis transfer for pediatric proximal humerus reconstruction // Plast. Reconstr. Surg. 2013. Vol. 132. No. 2. P. 281e–287e. DOI: 10.1097/prs.0b013e31829589fb

[27] Innocenti M, Ceruso M, Manfrini M, et al. Free vascularized growth-plate transfer after bone tumor resection in children. J Reconstr Microsurg. 1998;14(02):137–143. DOI: 10.1055/s-2007-1000157

[28] Innocenti M., Ceruso M., Manfrini M. et al. Free vascularized growth-plate transfer after bone tumor resection in children // J. Reconstr. Microsurg. 1998. Vol. 14. No. 2. P. 137–143. DOI: 10.1055/s-2007-1000157

[29] Ishiura R, Sawaizumi M. Long-term results of vascularized proximal fibula epiphyseal transfer based on the anterior tibial artery in retrograde fashion. Clin Case Rep. 2020;8(6):1069–1072. DOI: 10.1002/ccr3.2810

[30] Ishiura R., Sawaizumi M. Long-term results of vascularized proximal fibula epiphyseal transfer based on the anterior tibial artery in retrograde fashion // Clin. Case Rep. 2020. Vol. 8. No. 6. P. 1069–1072. DOI: 10.1002/ccr3.2810

[31] Leckenby J, Grobbelaar A, Aston W. The use of a free vascularised fibula to reconstruct the radius following the resection of an osteosarcoma in a paediatric patient. J Plast Reconstr Aesthetic Surg. 2013;66(3):427–429. DOI: 10.1016/j.bjps.2012.08.007

[32] Leckenby J., Grobbelaar A., Aston W. The use of a free vascularised fibula to reconstruct the radius following the resection of an osteosarcoma in a paediatric patient // J. Plast. Reconstr. Aesthetic Surg. 2013. Vol. 66. No. 3. P. 427–429. DOI: 10.1016/j.bjps.2012.08.007

[33] Medrykowski F, Barbary S, Gibert N, et al. Vascularized proximal fibular epiphyseal transfer: Two cases. Orthop Traumatol Surg Res. 2012;98(6):728–732. DOI: 10.1016/j.otsr.2012.05.009

[34] Medrykowski F., Barbary S., Gibert N. et al. Vascularized proximal fibular epiphyseal transfer: Two cases // Orthop. Traumatol. Surg. Res. 2012. Vol. 98. No. 6. P. 728–732. DOI: 10.1016/j.otsr.2012.05.009

[35] Papadopulos N, Weigand C, Kovacs L, Biemer E. The free vascularized fibular epiphyseal transfer: Long-term results of wrist reconstruction in young patients. J Reconstr Microsurg. 2008;25(01):003–013. DOI: 10.1055/s-0028-1090614

[36] Papadopulos N., Weigand C., Kovacs L., Biemer E. The free vascularized fibular epiphyseal transfer: Long-term results of wrist reconstruction in young patients // J. Reconstr. Microsurg. 2008. Vol. 25. No. 1. P. 3–13. DOI: 10.1055/s-0028-1090614

[37] Pho R, Patterson M, Kour AK. Free vascularised epiphyseal transplantation in upper extremity reconstruction in upper extremity reconstruction. J Hand Surg Br. 1988;13(4):440–447. DOI: 10.1016/0266-7681(88)90175-1

[38] Pho R., Patterson M., Kour A.K. Free vascularised epiphyseal transplantation in upper extremity reconstruction in upper extremity reconstruction // J. Hand Surg. Br. 1988. Vol. 13. No. 4. P. 440–447. DOI: 10.1016/0266-7681(88)90175-1

[39] Santanelli di Pompeo F, Selvaggi G, Longo B, et al. Double-barrel vascularized dual fibula transfer with epiphyseal growth plate for hip reconstruction: A case report. Microsurgery. 2018;38(5):572–575. DOI: 10.1002/micr.30303

[40] Santanelli di Pompeo F., Selvaggi G., Longo B. et al. Double-barrel vascularized dual fibula transfer with epiphyseal growth plate for hip reconstruction: A case report // Microsurgery. 2018. Vol. 38. No. 5. P. 572–575. DOI: 10.1002/micr.30303

[41] Sawaizumi M, Maruyama Y, Okajima K, Motegi M. Free vascularised epiphyseal transfer designed on the reverse anterior tibial artery. Br J Plast Surg. 1991;44(1):57–59. DOI: 10.1016/0007-1226(91)90181-i

[42] Sawaizumi M., Maruyama Y., Okajima K., Motegi M. Free vascularised epiphyseal transfer designed on the reverse anterior tibial artery // Br. J. Plast. Surg. 1991. Vol. 44. No. 1. P. 57–59. DOI: 10.1016/0007-1226(91)90181-i

[43] Shammas R, Avashia Y, Farjat A, et al. Vascularized fibula-based physis transfer. Plast Reconstr Surg Glob Open. 2017;5(5):1352–1365. DOI: 10.1097/gox.0000000000001352

[44] Shammas R., Avashia Y., Farjat A. et al. Vascularized fibula-based physis transfer // Plast. Reconstr. Surg. Glob. Open. 2017. Vol. 5. No. 5. P. 1352–1365. DOI: 10.1097/gox.0000000000001352

[45] Shuck J, Wood B, Zarella C, et al. Near-complete humerus reconstruction in the pediatric patient with vascularized free fibula transfer. Plast Reconstr Surg Glob Open. 2016;4(12):1143–1156. DOI: 10.1097/gox.0000000000001143

[46] Shuck J., Wood B., Zarella C. et al. Near-complete humerus reconstruction in the pediatric patient with vascularized free fibula transfer // Plast. Reconstr. Surg. Glob. Open. 2016. Vol. 4. No. 12. P. 1143–1156. DOI: 10.1097/gox.0000000000001143

[47] Soldado F, Fontecha C, Haddad S, et al. Composite vascularized fibular epiphyseo-osteo-periosteal transfer for hip reconstruction after proximal femoral tumoral resection in a 4-year-old child. Microsurgery. 2012;32(6):489–492. DOI: 10.1002/micr.21988

[48] Soldado F., Fontecha C., Haddad S. et al. Composite vascularized fibular epiphyseo-osteo-periosteal transfer for hip reconstruction after proximal femoral tumoral resection in a 4-year-old child // Microsurgery. 2012. Vol. 32. No. 6. P. 489–492. DOI: 10.1002/micr.21988

[49] Takamoto K, Tsai T. Microsurgical reconstruction of congenital upper extremity deformities of malformations. Clin Case Rep. 2020;8(4):612–616. DOI: 10.1002/ccr3.2635

[50] Takamoto K., Tsai T. Microsurgical reconstruction of congenital upper extremity deformities of malformations // Clin. Case Rep. 2020. Vol. 8. No. 4. P. 612–616. DOI: 10.1002/ccr3.2635

[51] Taylor G, Surgeon P, Corlett R, et al. The anterior tibial vessels and their role in epiphyseal and diaphyseal transfer of the fibula: experimental study and clinical applications. Br J Plast Surg. 1988;41(5):451–469. DOI: 10.1016/0007-1226(88)90001-x

[52] Taylor G., Surgeon P., Corlett R. et al. The anterior tibial vessels and their role in epiphyseal and diaphyseal transfer of the fibula: experimental study and clinical applications // Br. J. Plast. Surg. 1988. Vol. 41. No. 5. P. 451–469. DOI: 10.1016/0007-1226(88)90001-x

[53] Yang Y, Zhang G, Huo Z, et al. Reconstruction of the distal ulnar epiphysis with vascularized proximal fibula including epiphysis in children after osteochondroma resection. Plast Reconstr Surg. 2013;132(5):784–789. DOI: 10.1097/prs.0b013e3182a3bf98

[54] Yang Y., Zhang G., Huo Z. et al. Reconstruction of the distal ulnar epiphysis with vascularized proximal fibula including epiphysis in children after osteochondroma resection // Plast. Reconstr. Surg. 2013. Vol. 132. No. 5. P. 784–789. DOI: 10.1097/prs.0b013e3182a3bf98

[55] Petersen M, Hovgaard D, Elberg J, et al. Vascularized fibula grafts for reconstruction of bone defects after resection of bone sarcomas. Sarcoma. 2010;2010:1–9. DOI: 10.1155/2010/524721

[56] Petersen M., Hovgaard D., Elberg J. et al. Vascularized fibula grafts for reconstruction of bone defects after resection of bone sarcomas // Sarcoma. 2010. Vol. 2010. P. 1–9. DOI: 10.1155/2010/524721

[57] Eward W, Kontogeorgakos V, Levin L, Brigman B. Free vascularized fibular graft reconstruction of large skeletal defects after tumor resection. Clin Orthop Relat Res. 2010;468(2):590–598. DOI: 10.1007/s11999-009-1053-x

[58] Eward W., Kontogeorgakos V., Levin L., Brigman B. Free vascularized fibular graft reconstruction of large skeletal defects after tumor resection // Clin. Orthop. Relat. Res. 2010. Vol. 468. No. 2. P. 590–598. DOI: 10.1007/s11999-009-1053-x

[59] Schwarz G, Disa J, Mehrara B, et al. Reconstruction of oncologic tibial defects in children using vascularized fibula flaps. Plast Reconstr Surg. 2012;129(1):195–206. DOI: 10.1097/prs.0b013e318230e463

[60] Schwarz G., Disa J., Mehrara B. et al. Reconstruction of oncologic tibial defects in children using vascularized fibula flaps // Plast. Reconstr. Surg. 2012. Vol. 129. No. 1. P. 195–206. DOI: 10.1097/prs.0b013e318230e463

[61] Menezes-Leite M, Dautel G, Duteille F, Lascombes P. Transplantation of the proximal fibula based on the anterior tibial artery. Anatomical study and clinical application. Surg Radiol Anat. 2001;22(5–6):235–238. DOI: 10.1007/s00276-000-0235-8

[62] Menezes-Leite M., Dautel G., Duteille F., Lascombes P. Transplantation of the proximal fibula based on the anterior tibial artery. Anatomical study and clinical application // Surg. Radiol. Anat. 2001. Vol. 22. No. 5–6. P. 235–238. DOI: 10.1007/s00276-000-0235-8

[63] San-Julian M, Aquerreta J, Benito A, Caadell J. Indications for epiphyseal preservation in metaphyseal malignant bone tumors of children: Relationship between image methods and histological findings. J Pediatr Orthop. 1999;19(4):543–548. DOI: 10.1097/00004694-199907000-00025

[64] San-Julian M., Aquerreta J., Benito A., Caadell J. Indications for epiphyseal preservation in metaphyseal malignant bone tumors of children: Relationship between image methods and histological findings // J. Pediatr. Orthop. 1999. Vol. 19. No. 4. P. 543–548. DOI: 10.1097/00004694-199907000-00025

[65] Germain M, Mascard E, Dubousset J, Nguefack M. Free vascularized fibula and reconstruction of long bones in the child – Our evolution. Microsurgery. 2007;27(5):415–419. DOI: 10.1002/micr.20384

[66] Germain M., Mascard E., Dubousset J., Nguefack M. Free vascularized fibula and reconstruction of long bones in the child – Our evolution // Microsurgery. 2007. Vol. 27. No. 5. P. 415–419. DOI: 10.1002/micr.20384

[67] Pederson W, Person D. Long bone reconstruction with vascularized bone grafts. Orthop Clin North Am. 2007;38(1):23–35. DOI: 10.1016/j.ocl.2006.10.006

[68] Pederson W., Person D. Long bone reconstruction with vascularized bone grafts // Orthop. Clin. North. Am. 2007. Vol. 38. No. 1. P. 23–35. DOI: 10.1016/j.ocl.2006.10.006

[69] Innocenti M, Baldrighi C, Menichini G. Long term results of epiphyseal transplant in distal radius reconstruction in children. Handchir Mikrochir Plast Chir. 2015;47(02):83–89. DOI: 10.1055/s-0035-1547304

[70] Innocenti M., Baldrighi C., Menichini G. Long term results of epiphyseal transplant in distal radius reconstruction in children // Handchir. Mikrochir. Plast. Chir. 2015. Vol. 47. No. 2. P. 83–89. DOI: 10.1055/s-0035-1547304

[71] Mayr J, Pierer G, Linhart W. Reconstruction of part of the distal tibial growth plate with an autologous graft from the iliac crest. J Bone Joint Surg Br. 2000;82-B(4):558–560. DOI: 10.1302/0301-620x.82b4.0820558

[72] Mayr J., Pierer G., Linhart W. Reconstruction of part of the distal tibial growth plate with an autologous graft from the iliac crest // J. Bone Joint Surg. Br. 2000. Vol. 82-B. No. 4. P. 558–560. DOI: 10.1302/0301-620x.82b4.0820558

[73] Rose P, Shin A, Bishop A, et al. Vascularized free fibula transfer for oncologic reconstruction of the humerus. Clin Orthop Relat Res. 2005;438:80–84. DOI: 10.1097/01.blo.0000179586.34727.5b

[74] Rose P., Shin A., Bishop A. et al. Vascularized free fibula transfer for oncologic reconstruction of the humerus // Clin. Orthop. Relat. Res. 2005. Vol. 438. P. 80–84. DOI: 10.1097/01.blo.0000179586.34727.5b

[75] Gebert C, Hillmann A, Schwappach A, et al. Free vascularized fibular grafting for reconstruction after tumor resection in the upper extremity. J Surg Oncol. 2006;94(2):114–127. DOI: 10.1002/jso.20326

[76] Gebert C., Hillmann A., Schwappach A. et al. Free vascularized fibular grafting for reconstruction after tumor resection in the upper extremity // J. Surg. Oncol. 2006. Vol. 94. No. 2. P. 114–127. DOI: 10.1002/jso.20326

[77] Zelenski N, Brigman B, Levin L, et al. The vascularized fibular graft in the pediatric upper extremity: A durable, biological solution to large oncologic defects. Sarcoma. 2013;2013:1–7. DOI: 10.1155/2013/321201

[78] Zelenski N., Brigman B., Levin L. et al. The vascularized fibular graft in the pediatric upper extremity: A durable, biological solution to large oncologic defects // Sarcoma. 2013. Vol. 2013. P. 1–7. DOI: 10.1155/2013/321201

[79] Abed R, Grimer R. Surgical modalities in the treatment of bone sarcoma in children. Cancer Treat Rev. 2010;36(4):342–347. DOI: 10.1016/j.ctrv.2010.02.010

[80] Abed R., Grimer R. Surgical modalities in the treatment of bone sarcoma in children // Cancer Treat. Rev. 2010. Vol. 36. No. 4. P. 342–347. DOI: 10.1016/j.ctrv.2010.02.010

[81] Grimer R. Surgical options for children with osteosarcoma. Lancet Oncol. 2005;6(2):85–92. DOI: 10.1016/s1470-2045(05)01734-1

[82] Grimer R. Surgical options for children with osteosarcoma // Lancet Oncol. 2005. Vol. 6. No. 2. P. 85–92. DOI: 10.1016/s1470-2045(05)01734-1

[83] Steals E, Colangeli M, Ali N, et al. Are complications associated with the repiphysis expandable distal femoral prosthesis acceptable for its continued use? Clin Orthop Rel Res. 2015;473(9):3003–3013. DOI: 10.1007/s11999-015-4355-1

[84] Steals E., Colangeli M., Ali N. et al. Are complications associated with the repiphysis expandable distal femoral prosthesis acceptable for its continued use? // Clin. Orthop. Rel. Res. 2015. Vol. 473. No. 9. P. 3003–3013. DOI: 10.1007/s11999-015-4355-1

[85] Benevenia J, Patterson F, Beebe K, et al. Results of 20 consecutive patients treated with the Repiphysis expandable prosthesis for primary malignant bone. Springerplus. 2015;4(1). DOI: 10.1186/s40064-015-1582-6

[86] Benevenia J., Patterson F., Beebe K. et al. Results of 20 consecutive patients treated with the Repiphysis expandable prosthesis for primary malignant bone // Springerplus. 2015. Vol. 4. No. 1. DOI: 10.1186/s40064-015-1582-6

[87] Hopyan S, Tan J, Graham H, Torode I. Function and upright time following limb salvage, amputation, and rotationplasty for pediatric sarcoma of bone. J Ped Orthop. 2006;26(3):405–408. DOI: 10.1097/01.bpo.0000203016.96647.43

[88] Hopyan S., Tan J., Graham H., Torode I. Function and upright time following limb salvage, amputation, and rotationplasty for pediatric sarcoma of bone // J. Ped. Orthop. 2006. Vol. 26. No. 3. P. 405–408. DOI: 10.1097/01.bpo.0000203016.96647.43

RIGHTS & PERMISSIONS

Lukyanov S.A., Proshchenko Y.N., Zorin V.I.