{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T02:30:22Z","timestamp":1771641022375,"version":"3.50.1"},"reference-count":45,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,8,25]],"date-time":"2021-08-25T00:00:00Z","timestamp":1629849600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Proximal tibial sarcoma resections result in a reconstructive challenge, necessitating joint and extensor mechanism reconstruction. The gait and functional outcomes for children reconstructed with a combination of megaprosthesis and pedicled fibular flap for extensor mechanism reconstruction, are presented.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Four patients, aged 11\u201318\u2009years old, were available for comprehensive analysis. The proximal tibial osteosarcoma was resected, and the reconstructive technique involved a megaprosthesis for the knee joint, used in combination with a pedicled fibula flap as a biologic structure for reinsertion of the knee extensor mechanism. Outcomes were measured with three\u2010dimensional gait analysis and patient questionnaires.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Minor postoperative wound issues occurred in some patients, requiring debridement with skin grafting. One patient fractured their transferred fibula, requiring fixation. The follow up period ranged from 1.7 to 24\u2009years postoperatively. The longevity and quality of reconstructions were strong, measured by both objective and patient\u2010reported outcomes. All patients reported independent walking &gt;500\u00a0m in the Functional Mobility Scale and rated their walking as a nine or 10 (out of 10) on the Functional Assessment Questionnaire. Knee society scoring revealed overall satisfaction rate of 75\u201380%. No patients required gait aids. The gait profile analysis revealed effective gait patterns, with patterns deviating 5.4\u20137\u00b0 from \u201ctypical gait.\u201d Deviations &gt;6.5\u00b0 are considered abnormal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The long\u2010term results of combining a megaprosthesis with a pedicled fibula flap for extensor reinsertion, revealed a high level of independent function. The patients performed well, without the need for aids, and gait study evidence of minimal gait deviations.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.30802","type":"journal-article","created":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T06:24:27Z","timestamp":1629959067000},"page":"753-761","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Pedicled fibular transfer for biologic knee extensor tendon reinsertion following proximal tibial resection in pediatric osteosarcoma: Long\u2010term outcomes"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5304-6844","authenticated-orcid":false,"given":"Will","family":"Alexander","sequence":"first","affiliation":[{"name":"Department of Plastic and Maxillofacial Surgery Royal Children's Hospital  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9033-7683","authenticated-orcid":false,"given":"Joseph","family":"Overland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela","family":"Thomason","sequence":"additional","affiliation":[{"name":"Hugh Williamson Gait Analysis Laboratory Royal Children's Hospital  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"O'Sullivan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Royal Children's Hospital  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leo","family":"Donnan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Royal Children's Hospital  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Coombs","sequence":"additional","affiliation":[{"name":"Department of Plastic and Maxillofacial Surgery Royal Children's Hospital  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,8,25]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.91B10.22212"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-016-4843-y"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000229291.21722.b5"},{"key":"e_1_2_9_5_1","volume-title":"Measuring walking: A handbook of clinical gait analysis","author":"Baker R.","year":"2013"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-30808-1_25-2"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gaitpost.2009.05.020"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1054\/arth.2001.25502"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199406000-00014"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.N.00447"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.63B2.7217150"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.20190"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0167-9457(91)90046-Z"},{"key":"e_1_2_9_14_1","first-page":"247","article-title":"Onlay fibular bone grafting in treatment of tibial fracture non\u2010union","volume":"130","author":"Dawson W. 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