Treatment of long bone defects in children: Microsurgical transplantation of a fibular fragment for replacement of long bone defects: A systematic review

BACKGROUND: The use of a vascularized fibular graft during reconstructive interventions on the limbs in children is a promising direction in the replacement of extensive bone defects in children.

AIM: This study aimed to conduct a systematic review of the literature on microsurgical transplantation of a fragment of the fibula in the replacement of long bone defects in children.

MATERIALS AND METHODS: Articles were searched in systems such as eLibrary, PubMed, and Google Scholar, with a search time range of 10 years (from 2012–2022, last query 11/08/2022). The following keywords were used for searching in Russian-language search engines: “replacement of bone defects in children” and “fibula transplantation in children,” and in the English-language search engines, “microsurgical and fibula,” “microvascular and fibula,” and “bone and defect” were used. After sorting the published studies, 17 publications were analyzed.

RESULTS: The study analyzed a total of 690 patients (mean age 12 ± 2.6 years). The predominant cause of the defects was malignant tumors in 647 patients (93.7% of all patients). Benign processes were also noted, which accounted for 0.87% of all patients: osteomyelitis, 2.0%; congenital pathology, 2.17%, and trauma, 1.45%. The mean follow-up period was 4.8 ± 2.4 years. The survival rate of patients with cancer was 78.4%. Donor-side complications accounted for 14.7% of all complications. Recipient-zone complications were frequent and accounted for 85.3% of all complications (n = 457 cases). The main type of complications reported in the studies was graft fracture or fracture at the graft-bone level (35.7% of all complications).

CONCLUSIONS: The use of a fragment of the vascularized fibula in the replacement of extensive bone defects enables a one-stage reconstruction of the limb with good long-term results in large segmental defects of various features. Despite the complications, this technique is one of the few that enables simultaneous limb reconstruction. The decision to use microsurgical fibula autotransplantation is based on the preference and surgical experience of the surgeon.