Fibula Free Flap Reconstruction of the Pelvis in Children after Limb-Sparing Internal Hemipelvectomy for Bone Sarcoma

Background: Neoadjuvant chemotherapy has improved the treatment of bone sarcomas, making wide resection with limb salvage frequently possible. However, resection of iliac tumors without reconstruction causes pelvic instability and significant leg length discrepancy. Free vascularized bone autograft reconstruction represents a potentially optimal method for iliac reconstruction because of the faster healing time and rapid hypertrophy of the grafts. Furthermore, living incorporated autograft may be more durable in the setting of radiation therapy or chemotherapy. The purpose of this study was to characterize the successful reconstruction of the pelvis in children using a triangular double-barrel fibula free flap following limb-sparing internal hemipelvectomy for sarcoma. Methods: A retrospective review of the operative records and patient charts was performed with identification of patient characteristics, operative details, postoperative outcomes, complications, and need for additional procedures. Results: Four patients were identified who underwent fibula free flap reconstruction of the hemipelvis following type I resection with preservation of the hip joint. The mean age of the patients was 13.4 years, with a mean follow-up of 7.2 years. Flap survival was 100 percent, no postoperative infections occurred, and there were no local recurrences. All four patients returned to independent ambulation. The female patient was ultimately able to bear two children. One patient required epiphysiodesis for leg length discrepancy. Conclusions: An "A-frame" double-barrel fibula free flap can be used effectively for reconstruction of the type I internal hemipelvectomy defect. It permits a return to ambulation and minimizes leg length discrepancy and other complications, which may be critical in the immature pediatric skeleton. (Plast. Reconstr. Surg. 125: 195, 2010.)