{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T02:43:45Z","timestamp":1784601825144,"version":"3.55.0"},"reference-count":37,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T00:00:00Z","timestamp":1713830400000},"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":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Post\u2010oncologic surgical reconstruction of lower limbs in pediatrics remains a challenging topic. Microsurgical techniques allow reconstructions of large bony defects. The use of vascularized fibular flap with allograft has proven to be an ideal biologic construct. We aim to assess the success rate of this operation, including flap survival, bony union, weight\u2010bearing ambulation, and complications in a long\u2010term follow\u2010up in our case series compared to the literature.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and methods<\/jats:title><jats:p>Our case\u2010series includes 18 femoral resections (9 osteosarcomas, 8 Ewing sarcoma, and 1 desmoid tumor) and 15 tibial resections (10 osteosarcoma, 4 Ewing sarcoma, and 1 Malignant Fibrous Histiocytoma). We collected patients' demographics, type of tumor, type of resection, defect size, fibula\u2010flap length, method of fixation, anastomosis site, follow\u2010up data, complications, and their management. All survivals were examined by X\u2010ray and CT\u2010scan to evaluate the morphological changes of the vascularized fibula and follow\u2010up. The functional evaluation was performed by the 30\u2010point Musculoskeletal Tumor Society Rating Score (MSTS) for the lower limb (Enneking et al., <jats:italic>Clinical Orthopaedics and Related Research<\/jats:italic> 1993(286):241\u2013246).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean age of the femur resection patients' group was 11.2\u2009years with a mean defect size of 14\u2009cm and a mean length of the fibular flap of 18\u2009cm; for the tibia the mean age was 12\u2009years with a mean defect size of 14\u2009cm and a mean length of the fibular flap of 16.6\u2009cm. The overall survival of the reconstructions at 5\u2009years follow\u2010up was 17 out 18 cases for the femur and 13 out of 15 cases for the tibia. <jats:italic>MSTS<\/jats:italic> score was 28.2 for the femur and 23.7 for the tibia. The average time of union of the fibula was seen after 5\u2009months, while allograft consolidation was observed around 19.7\u2009months. The mean time of follow\u2010up was 144.5\u2009months for the femur and 139.2\u2009months for the tibia. The complication rate observed was 7 out of 18 for the femur and 7 out of 15 for the tibia reconstructions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The viability of the fibula is a cornerstone in the success of reconstruction as well as the successful management of complications in intercalary defects after tumor resection in pediatrics to restore good functionality. Our results are in line with those reported in the literature in terms of overall complication rates. The high primary union of allograft, the high MSTS score obtained, and the low rate of severe complications reflect the mechanical role of this reconstructive technique over a long follow\u2010up.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.31172","type":"journal-article","created":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T10:39:38Z","timestamp":1713868778000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The use of vascularized fibula flap with allograft in post\u2010oncologic microsurgical bone reconstruction of lower limbs in pediatric patients"],"prefix":"10.1002","volume":"44","author":[{"given":"Delcroix","family":"Luca","sequence":"first","affiliation":[{"name":"Department of Plastic Reconstructive and Microsurgery AOU Careggi  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0095-2741","authenticated-orcid":false,"given":"Tamburello","family":"Sara","sequence":"additional","affiliation":[{"name":"Department of Plastic Reconstructive and Microsurgery AOU Careggi  Florence Italy"},{"name":"University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Innocenti","family":"Marco","sequence":"additional","affiliation":[{"name":"IRCCS\u2010Istituto ortopedico Rizzoli Bologna, Italy  Bologna Italy"},{"name":"Dipartimento di Scienze Biomediche, Neuromotorie Universit\u00e0 di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Campanacci Domenico","family":"Andrea","sequence":"additional","affiliation":[{"name":"University of Florence  Florence Italy"},{"name":"Department of Oncologic Orthopedic Surgery AOU Careggi  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,4,23]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctrv.2010.02.010"},{"key":"e_1_2_11_3_1","first-page":"200","article-title":"Incorporation and clinical results of large allografts of the extremities and pelvis","volume":"307","author":"Aho A. 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