{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T10:21:48Z","timestamp":1783333308467,"version":"3.54.6"},"reference-count":75,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T00:00:00Z","timestamp":1765843200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Osteosarcoma and Ewing sarcoma are the predominant malignant bone tumors of the lower limbs in children. With 5-year survival rates of 70\u201377% for localized disease, limb salvage with growth-compatible reconstruction has replaced amputation as the standard. This review aimed to synthesize current reconstruction strategies, propose an age-and defect-based decision algorithm, and highlight growth-preserving innovations for skeletally immature patients. Methods: This narrative review of surgical techniques\u2014including rotationplasty, biological reconstruction (vascularized\/non-vascularized fibula, allograft, recycled autograft, \u201chot dog\u201d composite), bone transport, and endoprosthetic replacement (modular, extendable, 3D-printed)\u2014was conducted, with a literature search covering January 1990 to October 2025 and emphasized pediatric studies published after 2020, emphasizing pediatric outcomes, complication profiles, and functional scores. Results: Across pediatric and mixed-age cohorts (typically n \u2248 10\u201330 per technique; median follow-up 3\u201310 years), rotationplasty demonstrated high durability with Musculoskeletal Tumor Society (MSTS) scores of 21\u201328\/30, especially in children &lt; 6 years. Biological reconstruction achieved &gt;80% union in defects &lt; 6 cm, while vascularized fibula grafts yielded 82\u201395% union for 6\u201315 cm defects. Bone transport produced reliable union for 3\u201315 cm defects but required prolonged fixation (40\u201360 days\/cm) and had high pin-tract infection rates (50\u201360%). Extendable endoprostheses demonstrated 5-year prosthesis survival of 54\u201387%, while early joint-preserving 3D-printed implants improved MSTS scores from 17 to 28 points in a pediatric series (n = 7, mean follow-up 30 months). Conclusions: Personalized reconstruction guided by a child-centered algorithm optimizes oncologic control, skeletal growth, and long-term function. Emerging 3D-printed joint-preserving implants and noninvasive lengthening technologies promise further reduction in revisions and complications in pediatric limb salvage.<\/jats:p>","DOI":"10.3390\/children12121700","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T12:47:26Z","timestamp":1765889246000},"page":"1700","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Current Strategies for Limb Salvage and Reconstruction in Pediatric Lower Extremity Malignant Bone Tumors: Focus on Growth Preservation and Functional Outcomes"],"prefix":"10.3390","volume":"12","author":[{"given":"Zhu","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Shanghai Children\u2019s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoqi","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Shanghai Children\u2019s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuchan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Shanghai Children\u2019s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhigang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Shanghai Children\u2019s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Li, T., Kong, X., and He, D. 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