SLR - August 2011 - Alissa Duncan
Reference: Selber, J.C., Treadway, C., Lopez, A., Lewis, V.A., Chang, D.W. The use of free flap for limb salvage in children with tumors of the extremities. Journal of Pediatric Surgery. 46: 736-744, 2011
Scientific Literature Review
Reviewed by: Alissa Duncan, DPM
Residency Program: OCPM- UHHS Richmond Medical Center
Podiatric Relevance:
The study evaluates the outcome of pediatric patients who underwent limb salvage with use of free fibular flaps.
Methods:
Twenty- two pediatric oncology patients were underwent limb salvage using free fibular flap. Multiple factors such as age, sex, adjuvant and neoadjuvant chemotherapy and radiation therapy, tumor histology, primary or recurrent tumor, anatomical location of tumor and multiple reconstruction variables were observed. Following reconstruction function outcomes were assessed using the protocol from the Musculoskeletal Tumor Society.
Results:
The majority of the patients were male (59%) and the median age was 13.5 years. Twenty one or the twenty two patients had sarcoma in which 45 % were lower extremity and 55% involved the upper extremity with an average bone defect length of 13.9 cm and soft tissue defect of 108cm2. Most common complications following surgery involved nonunion and wound dehiscence or infection. Patients with upper extremity tumors were found to have a higher Musculoskeletal Tumor Society score than those with lower extremity tumors.
ConclusionS:
Pediatric patients undergoing limb salvage procedures tend to have better outcomes when using free fibular flaps for the upper extremity versus when being used in the lower extremity for salvage. But, when used in the lower extremity it was found to have a better out come for distal defect then patients that had defects that were more proximal.