Biological reconstruction in the growing child after tumour resection: long-term outcomes of vascularized fibular epiphyseal transfer.
In a two-institution retrospective series of nine children undergoing vascularized fibular epiphyseal transfer after tumor resection, graft hypertrophy and occasional neo-joint remodeling were observed, but growth was unpredictable and mechanical complications were frequent.
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In a two-institution retrospective series of nine children undergoing vascularized fibular epiphyseal transfer after tumor resection, graft hypertrophy and occasional neo-joint remodeling were observed, but growth was unpredictable and mechanical complications were frequent.
Research significance
The reported clinical evidence suggests that VFET can provide a living reconstruction with hypertrophy and some remodeling potential after pediatric oncologic resection; inferentially, improved patient selection, growth surveillance, fixation, and non-union prevention might preserve this benefit while reducing the high mechanical complication burden, but the record does not establish these strategies or comparative superiority.
Source abstract
PURPOSE: Paediatric limb-salvage surgery after tumour resection is challenging because reconstruction must account for small skeletal dimensions, immature bone, and residual growth. This study aimed to evaluate the long-term clinical, radiological, functional, and oncological outcomes of vascularized fibular epiphyseal transfer (VFET) after paediatric oncological resection. METHODS: We retrospectively reviewed nine children who underwent VFET between 1995 and 2025 at two institutions. Surgical techniques, bone union, graft hypertrophy, neo-joint remodelling, growth-related changes, complications, functional outcomes, and oncological status were analysed. RESULTS: The mean age at surgery was 6.8 years (range, 2-14), and the mean follow-up was 105 months (range, 7-330). Reconstruction sites included the proximal humerus, proximal radius, proximal femur, and distal tibia. Mean resection length was 12.25 cm. Bone union was achieved in seven patients after a mean of 22 months. Graft hypertrophy was observed in all patients at one year, with a mean increase of 34%. Neo-joint remodelling occurred in three patients. Two patients developed proximal humeral graft overgrowth with instability and dislocation. Mechanical complications occurred in eight patients, mainly non-union and graft fracture. One-year complication-free survival was 33 ± 16%. Functional outcomes were better in the upper limb than in the lower limb. Three-year overall survival was 71 ± 18%. CONCLUSIONS: VFET is a demanding biological reconstruction option in growing children after tumour resection. Although graft hypertrophy and selected joint remodelling may occur, growth behaviour is unpredictable and mechanical complications are frequent.