Functional development of the donor leg after vascularized fibula graft in childhood

Purpose: To evaluate the effect of free vascularized fibula grafts on developing donor leg function, the authors reviewed their experience of procedures performed in children. Methods: Over a 10-year period, 30 children (average age 7.2 years, without gender concern) underwent fibula harvest via an anterolateral approach. Graft length averaged 6.0 cm. Follow-up averaged 8 years. Results: No vascular injury or shank dysplasia ensued. Neural injury occurred in 8 patients: to the profound peroneal nerve in 1 and to the superficial peroneal nerve in 7. Symptoms resolved spontaneously at 3 to 5 months in 6, but persisted in 2 patients in the latter group at 8 years' follow-up. Of 24 children who underwent rapid walking (200 m) followed by immediate stair climbing (50 steps), 2 (whose grafts were longer than average) had slight and 1 had obvious ankle pain. However, muscle strength and range of motion in the donor ankle were no different from values in the recipient leg in the 24 cases. X-ray findings showed that, with growth, the remaining 2 fibular segments in the donor leg became longer, but the length of the gap between did not change. Thus, the gap left by harvest became relatively shorter long after operation, benefiting the stability of the ankle joint in adulthood. Conclusion: Unlike free vascularized fibula grafts performed in adulthood, from which serious complications to the donor leg have been reported, the procedure performed in childhood appears not to have an adverse effect on functional development. J Pediatr Surg 35:1226-1229. Copyright © 2000 by W.B. Saunders Company.