The use of free flap for limb salvage in children with tumors of the extremities

Background: The purpose of this study was to evaluate long-term functional outcomes in pediatric oncology patients who underwent limb salvage using free flaps. Methods: All 22 pediatric oncology patients treated with a free flap for extremity salvage were included in the study from 1999 to 2008. Results: The median patient age was 13.5 years. All but one patient had sarcoma, which involved lower extremity in 45% and upper extremity in 55%. The median bone defect length was 13.9 cm: reconstructed with vascularized free fibula in 68% (in 23% osseous allograft was also used) and used fibula growth plate transfer in 23%. The mean soft tissue defect area was 108 cm²: reconstructed with latissimus dorsi flap in 4 patients, vertical rectus abdominus muscle flap in 2, and anterolateral thigh flap in 1. The majority of the complications were nonunion (14%) and wound infection/dehiscence (14%). The median Musculoskeletal Tumor Society score was 70. Patients with tumors in the upper extremity had significantly higher Musculoskeletal Tumor Society scores compared with lower extremity tumor patients (80 vs 50, P = .04); and among those with lower extremity tumors, patients with distal defects had better outcomes than patients with proximal defects (70 vs 40, P = .03). Conclusion: In pediatric oncology patients who need limb salvage, use of free flaps can result in good long-term functional outcomes.