Vascularized fibular grafts extended with vascularized periosteum in children.
OBJECTIVE
The purpose of this report is to evaluate the results of extending vascularized fibular grafts (VFG) with vascularized periosteum (VPG) in bone defect reconstruction in children.


METHODS
Retrospective study of 10 children, mean age at surgery was 9.8 years (range, 4-16 years). Origin of one defect was oncological (n = 5), septical (n = 2), traumatic (n = 2), or congenital (n = 1). In five cases the flap consisted of a VFG and a vascularized epiphyseal transfer (VFET) in five. Mean bone defect was 8.5 cm .Mean length of the vascularized periosteal extension was 5.5 cm (range 3.5-8) for VFET, 4.8 cm for VFG (range 3-8). Bone union was assessed with monthly radiographs.


RESULTS
Radiographs showed a periosteal callus at 4 weeks in all cases. Bone union was achieved at a mean of 8.4 weeks (range 4-12). Donor site complications included two cases of flexor hallucis longus contracture, and one case of surgical wound marginal necrosis following FVG. One transient tibialis anterior weakness and one tibialis anterior contracture occurred following VFET harvest. None required surgical treatment. Mean follow-up was 28.7 months (range 7-72).


CONCLUSIONS
The association of a vascularized periosteal extension with fibular flaps seems to accelerate flap to recipient bone union. © 2016 Wiley Periodicals, Inc. Microsurgery 37:410-415, 2017.
Pediatric Hand Surgery and Microsurgery Unit, Hospital Sant Joan De Deu. Universitat De Barcelona, Barcelona, Spain.
Francisco
F
Soldado
Pediatric Orthopedics Department, Hospital Sant Joan De Deu. Universitat De Barcelona, Barcelona, Spain.
Paula
P
Diaz-Gallardo
Pediatric Orthopedics Department, Hospital Sant Joan De Deu. Universitat De Barcelona, Barcelona, Spain.
Lidia
L
Sena-Cabo
Pediatric Orthopedics Department, Hospital Sant Joan De Deu. Universitat De Barcelona, Barcelona, Spain.
Ferran
F
Torner
Pediatric Orthopedics Department, Hospital Sant Joan De Deu. Universitat De Barcelona, Barcelona, Spain.
Josep
J
Bergua-Domingo
Radiology Department, UIME Hospital Da Luz, Lisboa, Portugal.
Vasco V
VV
Mascarenhas
Pediatric Orthopedics Department, Hospital Sant Joan De Deu. Universitat De Barcelona, Barcelona, Spain.
Jorge
J
Knorr
D000293:Adolescent; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005360:Fibula / Q000098:blood supply / Q000637:transplantation*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010521:Periosteum / Q000098:blood supply / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies