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

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

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.

 

Full Text

Restricted Access

About the authors

Sergey A. Lukyanov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: Sergey.lukyanov95@yandex.ru
ORCID iD: 0000-0002-8278-7032
SPIN-code: 3684-5167

PhD student

Russian Federation, Saint Petersburg

Yaroslav N. Proshchenko

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: yar-2011@list.ru
ORCID iD: 0000-0002-3328-2070
SPIN-code: 6953-3210

MD, PhD

Russian Federation, Saint Petersburg

Vyacheslav I. Zorin

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery; North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: zoringlu@yandex.ru.ru
ORCID iD: 0000-0002-9712-5509
SPIN-code: 4651-8232

MD, PhD

Russian Federation, Saint Petersburg; Saint Petersburg

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. 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
  3. 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
  4. 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
  5. 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
  6. Wood M, Gilbert A. Microvascular bone reconstruction. London: Dunitz; 1997.
  7. 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
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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
  20. 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
  21. 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
  22. 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
  23. 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
  24. 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
  25. 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
  26. 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
  27. 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
  28. 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
  29. 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
  30. 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
  31. 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
  32. 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
  33. 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
  34. 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
  35. 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
  36. 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
  37. 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
  38. 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
  39. 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
  40. 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
  41. Grimer R. Surgical options for children with osteosarcoma. Lancet Oncol. 2005;6(2):85–92. doi: 10.1016/s1470-2045(05)01734-1
  42. 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
  43. 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
  44. 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

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2021 Lukyanov S.A., Proshchenko Y.N., Zorin V.I.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС77-54261 от 24 мая 2013 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies