title: The use of vascularised bone capping to prevent and treat amputation stump spiking in the paediatric population.
abstract: BACKGROUND
  Overgrowth of the stump skeleton is a major complication seen in children after an amputation. In advanced cases, perforation of the bone spike through the skin can occur. Many surgical treatments have been employed to treat and prevent this, with best results seen when non-vascularised osteo-chondral bone grafts are placed to try to mimic a trans-articular amputation. We reviewed our outcomes using vascularized bone flaps to prevent and treat spiking.
  
  
  METHODS
  Between 2000 and 2016 we carried out six vascularised osteo-cartilaginous bone capping procedures. Five patients underwent the procedure as an adjunct to primary amputation and in a single patient it was used to treat established bone spiking. Trauma accounted for three cases, with the other three being tumour, vascular malformation and ischemia. Three patients had pedicled bone flaps placed on the amputation stump and three underwent free tissue transfer (free calcaneus, free scapular angle, and free proximal tibia). Five cases involved lower limb amputations, with one in the upper limb.
  
  
  RESULTS
  One patient had an early post-operative complication in the form of partial skin flap necrosis that required debridement and skin grafting. All bone flaps survived. Mean follow-up was 6.5 years. All patients had bony union with no development of stump spiking. Two patients required further procedures unrelated to the bone flaps.
  
  
  CONCLUSIONS
  Vascularised bone flaps to cap amputation stumps may be a safe and effective method of preventing and treating long-bone stump spiking following amputation in children.
authors.affiliation: Department of Plastic & Maxillofacial Surgery, Royal Children's Hospital, Victoria, 3052, Melbourne, Australia.
authors.forename: Adrian D
authors.identifier: http://orcid.org/0000-0001-5971-7012
authors.initials: AD
authors.lastname: Murphy
authors.affiliation: Department of Plastic & Reconstructive Surgery, John Radcliffe Hospital, Oxford, United Kingdom.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Atkins
authors.affiliation: Department of Plastic & Maxillofacial Surgery, Royal Children's Hospital, Victoria, 3052, Melbourne, Australia.
authors.forename: Damon J
authors.initials: DJ
authors.lastname: Thomas
authors.affiliation: Department of Plastic & Maxillofacial Surgery, Royal Children's Hospital, Victoria, 3052, Melbourne, Australia.
authors.forename: David
authors.initials: D
authors.lastname: McCombe
authors.affiliation: Department of Plastic & Maxillofacial Surgery, Royal Children's Hospital, Victoria, 3052, Melbourne, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Coombs
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000671:Amputation, Surgical / Q000009:adverse effects / Q000379:methods*; D000672:Amputation Stumps / Q000503:physiopathology / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D010372:Pediatrics; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply* / Q000637:transplantation*; D016896:Treatment Outcome; D034941:Upper Extremity / Q000601:surgery; D014945:Wound Healing / Q000502:physiology*