[Vascularized peroneal reconstruction after bloc resection of tumors or congenital malformations of the upper limb in children].
Limb salvage surgery is the standard care for most malignant tumor affecting the extremities in the child, and a vascularized fibula transfer is probably the most popular microsurgical option to reconstruct long-bone defects. Between 1994 and 1999, nine children with intractable diseases of the upper limb were treated using free vascularized fibula grafts (one patient had resection in 1983 and initially prosthetic reconstruction, then fibula transplant in 1996). There were 6 boys and 3 girls. Mean age was 10 years (between 6 and 16). Eight patients had defects after sarcoma resection, one had an aggressive enchondroma. The reconstructed sites were the humerus (= 6), the radius (n = 3). The length of the bone defect ranged from 8 to 19 cm (mean: 14.4 cm). The fibula head with the cartilage and the growth plate was used in 3 children. One girl, 4.5 years old with congenital pseudoarthrosis of radius and cubitus had a resection and reconstruction with a U shaped fibula transplant. One patient died from lung and brain metastasis, two years after the reconstruction. There were no local recurrences. The complications were numerous but usually benign; fracture of the grafted fibula n = 7, necessity of additional bone grafts (n = 4) malunion (n = 1) needed reoperation, pseudoarthrosis (n = 2) with reoperation, ankle valgus (n = 1) required reoperation, necrosis of the fibula head (n = 1), radial inclination (n = 1). The ten patients had bone union. The mean period required to obtain radiographic bone union was 5 months. The functional results of the remaining patients were evaluated according to the scale of ENNEKING. The results ranged from 21 to 30 points. Our results were satisfactory with regard to pain, emotional acceptance, manual dexterity. The vascularized fibula graft is indicated in children with large bone defects, more than 8 cm in the humerus, radius and ulna.
Germain
M A
MA
Département de Chirurgie Cervico-Faciale, Institut Gustave-Roussy, 39 rue Camille Desmoulins-94805 Villejuif.
Dubousset
J
J
Mascard
E
E
Kalifa
C
C
D000293:Adolescent; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002812:Chondroma / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005360:Fibula / Q000098:blood supply / Q000637:transplantation*; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D006811:Humerus; D008297:Male; D012516:Osteosarcoma / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D018579:Patient Selection; D011542:Pseudarthrosis / Q000151:congenital* / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D011884:Radius; D016059:Range of Motion, Articular; D012086:Reoperation; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods*; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014457:Ulna