Vascularized Free Fibula Flap for Limb Salvage After Long Bone Tumor Resection in Pediatric Patients: A Single-Center Seven-Year Experience From a Developing Country

Background Pediatric long bone sarcomas pose significant challenges, requiring a delicate balance between oncological control and limb preservation. Limb salvage surgery has emerged as a preferred approach, with vascularized free fibula flap reconstruction showing promise in achieving favorable outcomes. The objective of this study was to evaluate the clinical outcomes of limb salvage surgery, including complication rates, functional outcomes, long-term survival, and disease recurrence. Method A retrospective analysis was conducted on pediatric patients undergoing limb salvage surgery for long bone sarcomas using vascularized free fibula flaps. Data from a single center's experience over a seven-year period were analyzed, including patient demographics, tumor characteristics, surgical techniques, complications, and functional outcomes. Follow-up assessments were performed regularly to monitor bone healing, disease recurrence, and functional recovery. Results Fifteen pediatric patients underwent limb salvage surgery with vascularized free fibula flap reconstruction, with a focus on 10 cases meeting inclusion criteria. Osteosarcoma was the most common histological diagnosis (seven, 70%), predominantly affecting the lower extremities (six, 60%). Surgical procedures varied based on tumor location, with most reconstructions utilizing osteocutaneous fibula flaps (eight, 80%). The flap survival rate was 10 (100%), with no instances of flap failure. Immediate complications occurred in three (30%) of cases, primarily surgical site infections, while one patient experienced delayed non-union and fracture requiring additional surgery. Functional outcomes were generally favorable, with seven (70%) of patients retaining functional limbs during follow-up. Conclusion In conclusion, our study demonstrates that vascularized free fibula flap reconstruction in pediatric long bone sarcomas can achieve high flap survival and acceptable short-term functional outcomes. Our series supports the technical feasibility of this approach, and delayed complications such as non-union and metastasis underscore the need for careful long-term surveillance and further prospective studies.