Biological reconstruction in the growing child after tumour resection: long-term outcomes of vascularized fibular epiphyseal transfer

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.