title: The use of free flap for limb salvage in children with tumors of the extremities.
abstract: BACKGROUND
  The purpose of this study was to evaluate long-term functional outcomes in pediatric oncology patients who underwent limb salvage using free flaps.
  
  
  METHODS
  All 22 pediatric oncology patients treated with a free flap for extremity salvage were included in the study from 1999 to 2008.
  
  
  RESULTS
  The median patient age was 13.5 years. All but one patient had sarcoma, which involved lower extremity in 45% and upper extremity in 55%. The median bone defect length was 13.9 cm: reconstructed with vascularized free fibula in 68% (in 23% osseous allograft was also used) and used fibula growth plate transfer in 23%. The mean soft tissue defect area was 108 cm(2): reconstructed with latissimus dorsi flap in 4 patients, vertical rectus abdominus muscle flap in 2, and anterolateral thigh flap in 1. The majority of the complications were nonunion (14%) and wound infection/dehiscence (14%). The median Musculoskeletal Tumor Society score was 70. Patients with tumors in the upper extremity had significantly higher Musculoskeletal Tumor Society scores compared with lower extremity tumor patients (80 vs 50, P = .04); and among those with lower extremity tumors, patients with distal defects had better outcomes than patients with proximal defects (70 vs 40, P = .03).
  
  
  CONCLUSIONS
  In pediatric oncology patients who need limb salvage, use of free flaps can result in good long-term functional outcomes.
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Selber
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Christen
authors.initials: C
authors.lastname: Treadway
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Adriana
authors.initials: A
authors.lastname: Lopez
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Valerae O
authors.initials: VO
authors.lastname: Lewis
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. Electronic address: dchang@mdanderson.org.
authors.forename: David W
authors.initials: DW
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006801:Humans; D007866:Leg; D007867:Leg Bones / Q000601:surgery*; D008297:Male; D018482:Muscle, Skeletal / Q000637:transplantation; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D014184:Transplantation, Homologous; D016896:Treatment Outcome