Biological reconstruction: the use of a fibular flap in the treatment of diaphyseal defects in pediatric patients with malignant bone tumors

The use of vascularized fibula flaps for the reconstruction of diaphyseal defects after resection of malignant bone tumors has a long history and has proved to be an effective method. A unique advantage of this technique is that instead of massive titanium endoprosthesis the patient's own bone is used for repair. Between September 2013 and September 2021, reconstruction using a vascularized fibula flap was performed in 32 patients admitted to the Department of Oncology and Pediatric Surgery of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation. The median follow-up was 3.2 years. Complications were analyzed according to the Henderson classification. Despite a high rate of complications (37.5%), excellent and good functional results were achieved in 87.5% cases. To evaluate the functional outcomes after surgical treatment, we used the international MusculoSkeletal Tumor Society Score (MSTS). It is important to note that after this type of surgery, there are no restrictions in walking (in terms of distance) and practicing sports activities that are usually not recommended after endoprosthetic reconstruction, such as doing barbell leg exercises, skiing, running, and rock climbing. The study was approved by the Independent Ethics Committee and Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation.