title: Use of the vascularized free fibula graft with an arteriovenous loop for fusion of cervical and thoracic spinal defects in previously irradiated pediatric patients.
abstract: BACKGROUND
  Extensive spinal neoplasms are difficult to manage. Following resection, arthrodesis of the spine can be performed with instrumentation, but this often fails in the setting of radiation therapy. Use of the free fibula flap for anterior spinal fusion to correct deformities has been described in multiple studies, but its use for posterior spinal fusion has been limited. In addition, its use in the pediatric population for this purpose has not been reported.
  
  
  METHODS
  A retrospective review was performed of three pediatric cases of cervical and thoracic spine tumor resection with posterior fusion of the spine with a microvascular fibula flap over a 2-year period. Data recorded included patient demographics, medical/surgical history, indications for surgery, length of free fibula flap, recipient vessels, ischemic time, number of osteotomies performed on the fibula, complications, and time to computed tomography-documented fusion of the fibula to the remaining spinal column.
  
  
  RESULTS
  All three microvascular anastomoses were successfully performed using an arteriovenous loop of saphenous vein graft to the anterior neck or subscapular vessels. The average length of fibula harvested was 23.7 cm, the average length of ischemic time was 220 minutes, the number of osteotomies in all cases was two, and there was bony fusion at an average of 15.7 weeks postoperatively.
  
  
  CONCLUSIONS
  The free fibula flap is ideally suited for accelerated posterior spinal fusion after extensive resection of cervical or thoracic spinal neoplasms. An arteriovenous saphenous vein loop facilitates the microvascular anastomosis in this anatomical region that lacks suitable recipient vessels.
authors.affiliation: Philadelphia, Pa. From the Division of Plastic Surgery, University of Pennsylvania Health System, and the Divisions of Plastic Surgery and Neurosurgery, Children's Hospital of Philadelphia.
authors.forename: Shareef
authors.initials: S
authors.lastname: Jandali
authors.forename: Michael L
authors.initials: ML
authors.lastname: Diluna
authors.forename: Phillip B
authors.initials: PB
authors.lastname: Storm
authors.forename: David W
authors.initials: DW
authors.lastname: Low
mesh_terms: D000293:Adolescent; D001163:Arteriovenous Anastomosis; D016025:Bone Transplantation / Q000379:methods*; D002574:Cervical Vertebrae / Q000098:blood supply / Q000528:radiation effects / Q000601:surgery*; D005260:Female; D005360:Fibula / Q000637:transplantation*; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D013123:Spinal Fusion / Q000009:adverse effects; D013125:Spinal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D013904:Thoracic Vertebrae / Q000098:blood supply / Q000528:radiation effects / Q000601:surgery*; D016896:Treatment Outcome