title: Long-term outcomes following lower extremity sarcoma resection and reconstruction with vascularized fibula flaps in children.
abstract: BACKGROUND
  Limb salvage operations in patients with bony oncologic defects carry technical challenges and may require long recoveries. This study aimed to evaluate functional outcomes, donor-site morbidity, and complications in lower limb bony oncologic defects reconstructed with vascularized fibula flaps in children.
  
  
  METHODS
  The authors performed a retrospective review of consecutive pediatric patients undergoing this procedure between 1994 and 2012. Data on operative details, functional outcomes, and complications were analyzed. A telephone survey was conducted to assess patient satisfaction and quality of life.
  
  
  RESULTS
  Eighteen patients who underwent 19 reconstructions were included. Mean age at resection was 10 years (range, 1.5 to 17 years). No patients developed local recurrence, although two patients had metastatic lung nodules resected. All patients were alive at last review, with a mean follow-up of 57 months (range, 10 to 145 months). Flap survival was 95 percent. Median time to bony union was 24 months (range, 9 to 72 months). The fibula flap fracture rate was 52.6 percent. At the end of the study period, 72 percent of patients were fully weight-bearing, all school-age children had returned to full-time school, and 50 percent were involved in sports. Fifty-six percent of patients participated in the follow-up telephone survey; of these, 90 percent expressed satisfaction with the outcome of the surgery.
  
  
  CONCLUSIONS
  This study demonstrates that the vascularized fibula flap is an excellent option for reconstruction of lower limb oncologic defects in children. Despite complications, long-term follow-up suggests that most children are able to lead active lifestyles.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Toronto, Ontario, Canada From the Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, and the University of Toronto.
authors.forename: David C G
authors.initials: DCG
authors.lastname: Sainsbury
authors.forename: Edward H
authors.initials: EH
authors.lastname: Liu
authors.forename: M Cecilia
authors.initials: MC
authors.lastname: Alvarez-Veronesi
authors.forename: Emily S
authors.initials: ES
authors.lastname: Ho
authors.forename: Sevan
authors.initials: S
authors.lastname: Hopyan
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Zuker
authors.forename: Gregory H
authors.initials: GH
authors.lastname: Borschel
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005266:Femoral Neoplasms / Q000601:surgery*; D005360:Fibula / Q000637:transplantation; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery*; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D013977:Tibia; D013997:Time Factors; D060053:Transplant Donor Site; D016896:Treatment Outcome