Purpose of the study: Transfer of a vascularised fibular is an option after tumour resection to save the limb.

Material and methods: Thirty-eight consecutive cases of malignant bone tumours located in the shaft of long bones of the lower limb were treated with a free transfer of a vascularised fibula. There were 30 femoral localisations and 8 tibial localisations, 32 first-intention transfers and six transfers after failure of an allograft. Mean age at transfer was 11.8 years (range 4.33–22.57). Adapted chemotherapy was associated. The Musculo-skeletal Tumour Society score was noted for the functional assessment. Healing was considered achieved when there was a bone bridge between the transplant and the recipient bone associated with disappearance of the osteotomy line. Outcome was expressed as mean or percentage with the 95% confidence interval. P< 0.05 was considered significant.

Results: Mean follow-up for the 38 patients was 7.56 years (range 0.37–18.4). The mean MSTS was 27.2 (range 20–30).. This mean score was significantly higher (S t = 2.11> 2.04) for vascularised fibular transfer surgery immediately after tumour resection (27.4) than after revision surgery (25.4). The healing rate was 89%. The rate of healing failure of the vascularised free transfer was significantly greater (p=0.005< 0.05) after revision (33%) than after immediate transfer (6%). The rate of good results in the Boer classification was significantly higher for tibial than femoral reconstructions (p=0.006< 0.05), for immediate surgery than revision surgery (p=0.005< 0.05), and for Ewing tumours than for osteosarcoma (p=0.0019< 0.05).

Discussion: Free transfer of a vascularised fibula is a reliable reconstruction technique for bone shaft loss of the lower limb after resection of a malignant bone tumour in children. This is a mutilating surgery with frequent complications but which can save the limb. This reconstruction surgery should be done at the same time as the resection. Healing of the vascularised fibular transplant is more difficult to achieve for femoral reconstructions than tibial reconstruction and there are more complications in the femoral localisation. Femoral reconstructions using a vascularised fibular transplant should be associated with an allograft.

Purpose: Therapeutic options for shaft reconstruction are allografts, shaft prosthesis, and autografts, which may be vascularised or not. The purpose of this work was to assess mid-term results and complications after upper limb reconstructions using a vascularised fibula in children and adolescents undergoing surgery for tumour resection.

Material and methods: A vascularised fibular graft was used for reconstruction in ten patients who underwent surgery for resection of upper limb tumours between 1994 and 2000. The patients were seven boys and three girls, aged seven to seventeen years. the vascularised fibula was used for reconstruction after tumour resection in the same operation for eight patients and to salvage a proximal humeral prosthesis in two patients. The eight single-procedure reconstructions concerned four resections of the humeral shaft and four resections of the radius. Tumour histology was: classical osteosarcoma (n=7), low-grade osteosarcoma (n=1), Ewing tumour (n= 1) and aggressive enchondroma (n=1). Six patients were on chemotherapy at the time of the fibular transfer.

Graft lengths varied from nine to 21 cm (mean 14 cm). Plate fixation was used in most cases. All patients wore a cast for six to twelve weeks after surgery.

Results: Results were analysed retrospectively after 3.9 years follow-up (range 1 – 7 years). Mean time to bone healing was three months (range 1.5 – 5 months). Five of the six humeral shaft reconstructions fractured due to trauma, requiring revision surgery in four cases. All patients who were reoperated achieved bone healing rapidly. One radius had to be revised to add supplementary bone. The mean functional score (MSTS) was 25.5/30 (range 21 – 30). One patient died from lung metastasis and the others exhibited complete tumour remission.

Discussion: Vascularised fibula reconstruction of the upper limb provides good radiological results, particularly for the radius. For the humerus, the results are better for younger children because the bone can grow in thickness. Certain mechanical complications may occur if normal sports activities are resumed too early. Functional outcome after these shaft reconstructions is nearly normal.