Proximal Fibula Flap for Upper Extremity Reconstruction in Pediatric Patients: A Multicentric Study

Background: Functional reconstruction to restore limb length of the upper limbs after sarcoma resection is always challenging for reconstructive surgeons, particularly in pediatric patients, keeping in mind the necessity of matching the growth of limbs. We present our cases of using vascularized proximal fibula free flap, along with physis based on anterior tibial vessels, for upper limb reconstruction. Methods: In this study, we conducted a retrospective analysis of 14 consecutive patients who underwent vascularized proximal fibula flap transfer for autologous functional reconstruction following oncologic resection of the humerus between April 2022 and April 2024. We evaluated all patients preoperatively and postoperatively, documenting outcomes like an increase in bone length, bony union, and donor site morbidity. Results: A total of 14 patients with an average age of 9.0 ± 2.4 years were included in this study. The average length of the humerus defect after surgical resection was 14.4 ± 2.3 cm. All patients had a smooth postoperative period with no wound healing issues and 100% flap survival rate. There was a measurable increase in bone flap length with complete bone union in all cases. One patient experienced brief common peroneal nerve palsy postoperatively. In none of the cases was knee instability noted. The mean follow-up period was 17.4 ± 2.6 months. The mean Musculoskeletal Tumor Society (MSTS) score was 29. Conclusion: Vascularized proximal fibula free flap based on anterior tibial vessels not only restores immediate limb length, but the growth allows long-term increase in limb length with minimal donor site morbidity.