ArticleJB & JS open access
Sufficiency of Isolated Vascularised Fibular Free Flaps for Pediatric Intercalary Lower Limb Reconstruction.
Article in JB & JS open access. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
4 authors.
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Abstract
Background: For intercalary defects after resection of pediatric sarcoma, an isolated vascularized free fibular graft (VFFG) offers a living bone option with the potential for durability but is underutilized due to concerns about mechanical sufficiency. By contrast, structural allograft is initially strong but is associated with a high complication profile with or without a composite VFFG (Capanna). Our aim was to compare the complications associated with allograft/VFFG composites to isolated VFFG. Methods: This is a retrospective comparison of 32 pediatric patients with primary femoral or tibial sarcoma. Reconstructions were categorized into 2 groups: allografts + VFFG (Capanna) (Group 1, n = 9) and "single barrel" isolated VFFG (Group 2, n = 23). Descriptive and inferential statistical analyses were performed. Results: No significant differences between the 2 groups were observed in age, sex, diagnosis, length of reconstruction, or follow-up (56 months (SD 29) for Group 1 and 53 months (SD 24) for Group 2). Group 1 participants exhibited a higher number of complications including the need for unplanned surgery (mean 2.9) compared with those in Group 2 (mean 1.6, p < 0.01). Disparities in bone healing were notable. At the final follow-up, 46% in Group 1 had achieved full consolidation compared with 96% in Group 2 (p = 0.002). Graft fractures and hardware failures were not different between the groups despite full weight-bearing among all subjects, suggesting mechanical equivalency within the follow-up period. The mean numbers of unplanned surgeries per participant were 4.2 ± SD 4.4 and 2.3 ± SD 2.5 for Groups 1 and 2, respectively (p = 0.149). Conclusions: Isolated single barrel VFFG reconstructions are structurally sound and had fewer complications and faster union than composite allograft/VFFG composites. Level of Evidence: Retrospective cohort study Level III. See Instructions for Authors for a complete description of levels of evidence.
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