This study was carried out to evaluate the long-term effect on the donor side of the foot and ankle following vascularized fibular graft resection in children. Eight patients underwent resection of the fibula for the purpose of a vascularized fibular graft by a surgical team who practiced leaving at least 6 cm residual distal fibula. The age of these children at the time of surgery was between 3 and 12 years. They were reviewed between 3 and 12 years after surgery. Two patients who underwent resection of the middle shaft of the fibula at 3 and 5 years of age developed abnormal growth of the distal tibia, leading to ankle valgus. They were treated with growth modulation of the distal tibial physis and supramalleolar osteotomy with tibiofibular synostosis. Another patient who underwent the entire proximal fibula resection at the age of 6 years had developed hindfoot valgus because of weakness of the tibialis posterior muscle. He required talonavicular fusion and flexor hallucis to tibialis posterior muscle transfer. Patients operated at the age of older than 8 years neither had ankle nor hindfoot deformity. We concluded that resection of the middle shaft of the fibula for the purpose of a vascularized fibula graft, leaving a 6 cm distal fibular stump in children younger than 6 years old, may give rise to abnormal growth of the distal tibial physis, leading to valgus ankle. The entire proximal fibular resection for the similar purpose in a 6-year-old child may give rise to weakness of tibialis posterior and hindfoot valgus.

No abstract

Segmental bone allografts are widely used in managing large cortical bone defects. To improve host-graft union, the effect of allograft on a large cortical tibial bone defect augmented with a non-vascularized periosteal flap was studied. Twelve mature Australian white rabbits (Oryctolagus cuniculus) were divided into intervention groups and a control group. Bone defects in the intervention groups were treated with segmental allografts wrapped with a non-vascularized periosteal flap. The control group was treated with allograft transplantation alone. Healing was evaluated at the end of the 2nd, 4th, and 6th weeks with plain radiographs, CT scan, and histology. In the intervention groups, the bony union was achieved at both ends of the allografts at the 4th to 6th weeks. Solid callus encasing the whole allograft segments at the end of the 6th week. In the control group, the union did not occur at both ends of the allograft segments even up to the end of the 6th week. No callus formation surrounding the allograft segments. Fragmentation and telescoping of the allograft segment into the medullary cavity of the host were observed. The use of autogenous, non-vascularized periosteal flap modified the healing process of allograft and maintained the integrity of the allograft.