title: The use of massive bone allograft with intramedullary free fibular flap for limb salvage in a pediatric and adolescent population.
abstract: BACKGROUND
  Long segmental bony defects after tumor extirpation can pose difficult problems for the reconstructive surgeon. Capanna and colleagues have described a technique that places a free fibular flap within the intramedullary canal of an allograft for reconstruction of large intercalary bony defects. This article describes the authors' long-term follow-up with this technique for the treatment of large segmental bone defects in a pediatric population.
  
  
  METHODS
  Over a 6-year period, seven patients underwent bony reconstruction with an allograft and vascularized fibular construct. All reconstructions were performed for lower extremity salvage after tumor extirpation. Grafts were evaluated for viability with bone scans 10 days postoperatively. Radiologic and clinical evaluations were performed on all patients. Time to union was recorded through evaluation of plain radiographs. Patients' charts were evaluated for postoperative complications.
  
  
  RESULTS
  There were two female and five male patients with an average age of 10.5 years. The average follow-up time was 36 months (range, up to 72 months). Limb salvage was 100 percent, with all bone scans positive at 10 days. Two nonunions at the allograft interface were treated successfully with a secondary bone graft. The average time to complete bony union of the fibula and allograft to the native bone was 9 months. There were no allograft fractures and no infections. One patient developed nonunion at the donor leg syndesmosis site. Average final knee motion was 110 degrees. All patients returned to ambulation.
  
  
  CONCLUSIONS
  Intramedullary free fibular flaps in combination with massive bony allografts provide an excellent option in the pediatric population for reconstruction of large bony defects after tumor extirpation.
authors.affiliation: Mayo Medical School, Mayo Clinic, Rochester, Minn. 55905, USA. moran.steven@mayo.edu
authors.forename: Steven L
authors.initials: SL
authors.lastname: Moran
authors.forename: Alex Y
authors.initials: AY
authors.lastname: Shin
authors.forename: Allen T
authors.initials: AT
authors.lastname: Bishop
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005360:Fibula / Q000637:transplantation*; D005500:Follow-Up Studies; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery; D013524:Surgical Flaps; D014184:Transplantation, Homologous; D014947:Wounds and Injuries / Q000209:etiology / Q000601:surgery*