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Blanco MD, de la Torre M, Lorca C, Del Cañizo A, Bada I, Monje S, García-Casillas MA, Villa Á, de Tomás E, Berenguer B. Use of pedicled flaps after oncologic resections in pediatric patients. Pediatr Surg Int 2024; 40:64. [PMID: 38433161 DOI: 10.1007/s00383-024-05654-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
The aim of this study is to review the indications of pedicled flaps and analyze the results. A observational retrospective study of under 18-year-old oncology patients who required reconstructive surgery with pedicled flaps between 2011 and 2022 was performed. Demographic and clinical variables, indications, complications, and outcomes were collected. 236 patients were reviewed and 13 met inclusion criteria, eight girls and five boys (mean age: 10.6 years). Indications were Ewing's sarcoma (5), osteosarcoma (5), neuroblastoma, desmoid tumor, and neurofibroma. Preoperative PET-CT, MRI and bone scintigraphy were performed. The flaps were used on costal and extremity reconstruction: latissimus dorsi (5), pectoralis (2), medial gastrocnemius (2), combined latissimus dorsi, trapezius and serratus muscle, biceps femoris, fascio-neuro-cutaneous saphenous and cutaneous advancement-rotation. Two were performed on allograft and eight on prosthesis. All allowed immediate and complete closure. Six patients received intraoperative radiotherapy. One flap infection and two vascular complications were reported, a total necrosis, which required a new flap, and a partial necrosis, treated with a local plasty. Chemotherapy was resumed after 21 days (15-31). Mean follow-up time was 5.34 years. Flaps are an effective therapeutic option allowing reconstruction of large defects after pediatric oncologic surgeries. The most frequent complication was vascular.
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Affiliation(s)
- María Dolores Blanco
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
- Department of Pediatric Surgery, Hospital Materno Infantil Gregorio Marañón, C/O'Donnell, 48, 28009, Madrid, Spain.
| | - Manuel de la Torre
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Concepción Lorca
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Agustín Del Cañizo
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Isabel Bada
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sara Monje
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Ángel Villa
- Pediatric Traumatology Department Hospital General, Universitario Gregorio Marañón, Madrid, Spain
| | - Elena de Tomás
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Beatriz Berenguer
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Mueller MA, Mericli AF, Roubaud MS, Liu J, Adelman D, Lewis VO, Lin PP, Hanasono MM. Comparing Fibula Flap Insetting Techniques for Pediatric Oncologic Extremity Reconstruction. Plast Reconstr Surg 2024; 153:636e-643e. [PMID: 37166051 DOI: 10.1097/prs.0000000000010613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Extremity reconstruction in skeletally immature patients presents unique challenges in terms of operative technique, bone healing, and limb function. A variety of insetting techniques have been described, with no clearly superior option. The authors hypothesized that vascularized fibula flaps placed in the intramedullary space are associated with shorter union times and better functionality compared with onlay flaps. METHODS In a cohort study, the authors retrospectively reviewed the medical records of all pediatric patients who underwent fibula flap extremity reconstruction at a single center from 2001 through 2018. Comorbidities, complications, and outcomes were analyzed. Complete fibula union was based on radiographic evidence of significant cortical bridging. RESULTS Thirty-three patients (mean age, 13.6 years; range, 2 to 18 years) underwent pedicled ( n = 7) or free ( n = 26) fibula flap reconstructions in 12 upper extremities and 21 lower extremities. Median follow-up was 69.5 months (interquartile range, 16.3 to 114.6 months). Onlay and intramedullary fibula position compared with intercalary placement (median, 13.5 and 14.6 months versus 3.4 months; P = 0.002) were associated with longer time to complete bone union. Complications including allograft fracture ( P = 0.02) and hardware removal ( P = 0.018) were also associated with longer time to complete union and eventual conversion to megaprosthesis ( P = 0.02, P = 0.038). Thirty-two patients (97%) achieved full union and a functional reconstruction. CONCLUSIONS Fibula flap reconstruction is safe and effective for pediatric long-bone reconstruction. Longer fibula union times were associated with onlay and intramedullary fibula placement, allograft fracture, and hardware removal. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
| | | | | | - Jun Liu
- From the Departments of Plastic Surgery
| | | | - Valerae O Lewis
- Orthopaedic Oncology, The University of Texas MD Anderson Cancer Center
| | - Patrick P Lin
- Orthopaedic Oncology, The University of Texas MD Anderson Cancer Center
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Du W, Zhou W, Zhou L, Wang Y, Yan C, Al-Aroomi MA, Pang P, Sun C. Donor-site morbidity of free fibula flap in pediatric patients: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2023; 83:207-214. [PMID: 37276738 DOI: 10.1016/j.bjps.2023.04.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/01/2023] [Accepted: 04/11/2023] [Indexed: 06/07/2023]
Abstract
The morbidity of free fibula flap (FFF) in pediatric patients has gained attention. Thus, we aimed to evaluate donor-site morbidity after FFF harvesting in pediatric patients and its relationship with age. A systematic literature search of databases for cross-sectional studies related to pediatric donor-site morbidity after FFF harvesting was performed. Two independent reviewers evaluated relevant article titles and abstracts to extract data regarding donor-site morbidity from each article. Fifteen studies were included in the meta-analysis that evaluated the rate of complications. Individual cases of ankle instability were divided into the 0-13- and 13-17-year-old groups. The Chi-square test was used to compare ankle instability between both groups. A logistic regression model was created to analyze the relationships between age and ankle instability/claw toe. Sixteen English articles published between 2007 and 2021 were included in the systematic review. Information on morbidities of 294 cases in which FFF was used was collected. The mean incidence rate of complications, instability, claw toe, and nerve injury were 19.3%, 12.9%, 5.9%, and 5.1%, respectively. Bivariate analysis showed that age was significantly correlated with the incidence of ankle instability but not with the incidence of claw toe. The Chi-square test showed that the incidence rate of ankle instability between the age groups was significantly different. Therefore, we recommend 14 years of age as a new predictive factor for ankle instability. Nevertheless, there is limited evidence in this field, and more pediatric research is needed to clarify these findings.
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Affiliation(s)
- Weidong Du
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, No. 117, Nanjing Bei Street, Heping District, Shenyang, Liaoning 110002, People's Republic of China.
| | - Wanghang Zhou
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, No. 117, Nanjing Bei Street, Heping District, Shenyang, Liaoning 110002, People's Republic of China.
| | - Lu Zhou
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, No. 117, Nanjing Bei Street, Heping District, Shenyang, Liaoning 110002, People's Republic of China.
| | - Yao Wang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, No. 117, Nanjing Bei Street, Heping District, Shenyang, Liaoning 110002, People's Republic of China.
| | - Cong Yan
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, No. 117, Nanjing Bei Street, Heping District, Shenyang, Liaoning 110002, People's Republic of China.
| | - Maged Ali Al-Aroomi
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, No. 117, Nanjing Bei Street, Heping District, Shenyang, Liaoning 110002, People's Republic of China.
| | - Pai Pang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, No. 117, Nanjing Bei Street, Heping District, Shenyang, Liaoning 110002, People's Republic of China.
| | - Changfu Sun
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, No. 117, Nanjing Bei Street, Heping District, Shenyang, Liaoning 110002, People's Republic of China.
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He SY, Yu B, Jiang N. Current Concepts of Fracture-Related Infection. Int J Clin Pract 2023; 2023:4839701. [PMID: 37153693 PMCID: PMC10154639 DOI: 10.1155/2023/4839701] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/24/2023] [Accepted: 04/08/2023] [Indexed: 05/10/2023] Open
Abstract
Currently, fracture-related infection (FRI) still represents great challenges in front of orthopaedic surgeons, despite great advances that have been achieved regarding its diagnosis and treatment. Although both FRI and prosthetic joint infection (PJI) belong to osteoarticular infections and share similarities, FRI displays unique characteristics. Diagnosis of FRI is sometimes difficult owing to the nonspecific symptoms, and treatment is usually tricky, with a high risk of infection recurrence. In addition, the long disease course is associated with a significantly elevated risk of disability, both physically and psychologically. Moreover, such a disorder still poses heavy economic burdens to the patients, both personally and socially. Therefore, early diagnosis and reasonable treatment are the key issues for increasing the cure rate, decreasing the risks of infection relapse and disability, and improving the life quality and prognosis of the patients. In this review, we summarized the present concepts regarding the definition, epidemiology, diagnosis, and treatment of FRI.
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Affiliation(s)
- Si-ying He
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
| | - Bin Yu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
| | - Nan Jiang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
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Rosli MA, Wan Ismail WF, Wan Sulaiman WA, Mat Zin NA, Abdul Halim S, Mat Johar F, Mat Saad AZ, Halim AS. Calcaneal Reconstruction With Free Deep Circumflex Iliac Artery Osseocutaneous Flap Following Aggressive Benign Bone Tumor Resection. Foot Ankle Int 2021; 42:1570-1578. [PMID: 34286617 DOI: 10.1177/10711007211025280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Advances in limb-salvage techniques have made total calcanectomy and primary reconstruction possible in managing calcaneal aggressive benign tumors and selected cases of intraosseous malignant tumors. However, there is still no consensus on the operative approach, oncologic margin, and the best reconstruction method to date. These 2 cases describe our experience in calcaneal reconstruction with the free deep circumflex iliac artery (DCIA) osseocutaneous flap in benign aggressive calcaneal tumors. METHODS We reported 2 consecutive male and female patients, with an average age of 25 years (age 19 and 31, respectively), who underwent total calcanectomy and primary calcaneal reconstruction with the free DCIA osseocutaneous flaps for calcaneal chondroblastoma and giant cell tumor. A marginal resection of the entire calcaneus through the subtalar and calcaneocuboid joints (intra-articular approach) was performed in the first case and a wide local resection leaving 1 cm normal calcaneal bone margin anterosuperiorly (intraosseous approach) was performed in the second case. RESULTS The follow-up period averaged 48 months. Negative oncologic margins were achieved in both cases. The first case was complicated with venous thrombosis; however, the graft remained viable after emergency reexploration. Normal foot function was restored with good solid osseous union and bony hypertrophy observed. Both patients achieved good short-term functional and aesthetic outcomes with no donor site pain or disability. No local recurrence was reported either. CONCLUSION Primary calcaneal reconstruction with the free DCIA osseocutaneous flap can lead to good short-term functional and aesthetic outcomes. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Mohamad Aizat Rosli
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Wan Faisham Wan Ismail
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Orthopaedic Oncology and Reconstructive Unit (OORU), School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Wan Azman Wan Sulaiman
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Nor Azman Mat Zin
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Orthopaedic Oncology and Reconstructive Unit (OORU), School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Syurahbil Abdul Halim
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Orthopaedic Oncology and Reconstructive Unit (OORU), School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Fatimah Mat Johar
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Arman Zaharil Mat Saad
- Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Plastic & Reconstructive Unit, MSUMC, Management and Science University, University Drive, Off Persiaran Olahraga, Shah Alam, Selangor, Malaysia
| | - Ahmad Sukari Halim
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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Rosli MA, Sulaiman WAW, Ismail WFW, Yahaya S, Saad AZM, Wan Z, Halim AS. Functional outcomes in total talus reconstruction with triangular double-barrel free fibula flap following oncological resection: A retrospective case series review. J Plast Reconstr Aesthet Surg 2021; 75:641-650. [PMID: 34756555 DOI: 10.1016/j.bjps.2021.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 09/04/2021] [Accepted: 09/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND With the advent of new techniques, foot salvage is feasible following talus oncological resection. As the reconstruction aims to achieve a pain-free, stable ankle for ambulation, biological limb reconstruction is the best option. This case series will evaluate the primary indications, complications, and functional outcomes of the reconstructed talus and highlighting the technical aspects of the surgery with a novel technique of triangular double-barrel free fibula flap. METHODS We performed a retrospective case note review of patients undergoing foot salvage surgeries and primary talus reconstruction with double-barrel free fibula flaps between 2009 and 2019. Patient demographics, aetiologies, operative details, complications, and outcomes were analysed. All patients underwent the same talar reconstruction technique whereby a wide-based triangular framework was created from two bony struts of the osteotomized fibula. The Musculoskeletal Tumour Society (MSTS) scoring system was used to analyse the short- to mid-term functional outcomes. RESULTS Four consecutive patients with aggressive benign and malignant tumours were identified. They consist of three males and one female, with a median age of 32 (range 27-39). Patients were followed up for a median duration of 60 months (range 24-132). Two flaps were complicated with venous thromboses; however, all were salvageable following re-explorations. All patients achieved solid bony fusion with good functional and aesthetic outcomes. The median MSTS score was 74.5% (range 66-76). No donor site morbidity and local recurrence were reported. CONCLUSION The triangular double-barrel free fibular flap is a good option for limb salvage following total talus resection, with good short- to mid-term functional and aesthetic outcomes.
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Affiliation(s)
- Mohamad Aizat Rosli
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia; Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus. Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Wan Azman Wan Sulaiman
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia; Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus. Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Wan Faisham Wan Ismail
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia; Orthopaedic Oncology and Reconstructive Unit (OORU), School of Medical Sciences, Medical Campus. Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.
| | - Sahran Yahaya
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia; Orthopaedic Oncology and Reconstructive Unit (OORU), School of Medical Sciences, Medical Campus. Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Arman Zaharil Mat Saad
- Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus. Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia; Plastic & Reconstructive Unit, MSUMC, Management and Science University, University Drive, Off Persiaran Olahraga, Shah Alam, Selangor 40100, Malaysia
| | - Zulmi Wan
- Orthopaedic Oncology and Reconstructive Unit (OORU), School of Medical Sciences, Medical Campus. Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia; Orthopaedic Oncology and Reconstructive Unit (OORU), Prince Court Medical Centre, Jalan Kia Peng, Kuala Lumpur, Kuala Lumpur 50450, Malaysia
| | - Ahmad Sukari Halim
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia; Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus. Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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