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J Am Acad Orthop Surg, Vol 15, No 10, October 2007, 577-587.
© 2007 the American Academy of Orthopaedic Surgeons
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The Use of Free Vascularized Fibular Grafts in Skeletal Reconstruction for Bone Tumors in Children

Michelle Ghert, MD, Nigel Colterjohn, MD and Marco Manfrini, MD

Dr. Ghert is Assistant Professor, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada. Dr. Colterjohn is Clinical Assistant Professor, Division of Orthopaedic Surgery, McMaster University. Dr. Manfrini is Professor of Orthopaedic Surgery, Instituto Ortopedica Rizzoli, Bologna, Italy.

None of the following authors or a member of their immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Ghert and Dr. Colterjohn. Dr. Manfrini or a member of his immediate family has received research or institutional support from AIRC (Italian Association for Cancer Research).

Reprint requests: Dr. Ghert, McMaster University, 699 Concession Street, Hamilton, ON, L8V 5C2, Canada.

The reconstruction of large skeletal defects in children following resection of a bone tumor presents a unique challenge to the orthopaedic surgeon. Issues in this population that are not present in the adult population include significant remaining growth potential, the desire for biologic preservation of the joint surface, and the need for a long-term viable reconstruction in patients who are anticipated to survive for decades. The use of a free vascularized fibular graft, supplied by the peroneal vessels in intercalary fibular grafts and the anterior tibial vessels in proximal fibular grafts, has been shown to provide biologic reconstruction that successfully addresses these issues in the pediatric population. Specific techniques are applied in the upper and lower extremity to provide long-term excellent functional results. Experience in microvascular surgery and careful postoperative care are required for the success of these procedures.






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Copyright © 2007 by the American Academy of Orthopaedic Surgeons.