We are looking for any help from anywhere for our daughter. She has a large bone tumor that has to be removed. This will shorten her leg considerably and possibly cause other problems later. Our surgeon is consulting with her colleagues about this but we are doing an intensive search on-line as well. Do you know of anything that could help in a case like this?

There was a recent report from Spain about a new surgical technique for complex, challenging cases like your daughter. They used a technique called vascularized fibular periosteal graft. Their report gives the results of a dozen children who received this treatment.

A fibular periosteal flap is a piece of bone taken from the fibula the smaller bone in the lower leg. A special tool called a periosteal elevator is used to lift the top layer of bone, which is then transferred to the site where it is needed.

If the bone is used in the same leg, then blood vessels to the bone can be taken at the same time. This is called a pedicled graft. If the bone graft is used anywhere else, the donor bone is taken without attached blood vessels (called a free flap). With a free flap, the surgeon must perform microsurgery to connect the bone graft to local blood vessels (at the site of placement).

Once the procedure has been completed, the wait begins. In places where the bone is close enough to the surface, it may be possible to palpate or feel the new bone growing. New bone forms a callus (bony knob) that will eventually be remodeled by the body’s own healing processes and become smooth once again.

The callus can often be felt two to three weeks after the bone graft procedure. Otherwise, serial (repeated) X-rays and CT scans can be used to assess results. Special ultrasound Doppler tests are used to monitor blood flow.

Using this new technique, the authors report success in all but one case. In the one case where it didn’t work, the blood vessel attached to the bone graft was twisted so blood was not getting to the graft site. A second surgery to repeat this technique was successful.

Healing time with progressive bone formation ranged between two and nine months. This is much faster than with allografts (bone from a donor bank). The length of time for bone to fill in the gap depended on the location of the problem (e.g., middle of the bone versus near the growth plate). The final bone union occurred in two stages: first along the outside (periosteal layer) and then the layers underneath forming the cortical (inside) layers.

The authors conclude that this new technique using periosteal bone (with or without blood vessels attached) is an effective way to stimulate fast bone growth in children. It’s not a method that is needed routinely but saved for children with complex bone loss too large to heal completely without some help.

Vascularized fibular periosteal graft is a new reconstructive strategy that works for children because of their unique ability to grow fast. This type of tissue transfer is successful because the bone has strong osteogenic (bone growth) properties and angiogenic (formation of blood vessels) abilities. Both the donor site and the graft site heal quickly and without problems. It may be one approach your surgeon wants to consider but there may be other more appropriate techniques recommended for your daughter’s situation.