Pediatric Fibula Harvest Carries High Risk of Ankle Valgus and Nerve Palsy

Microvascular free tissue transfer remains the established standard for reconstructing significant osseous defects following oncological resection or complex trauma in children [1, 2]. The vascularized fibula is frequently utilized for its reliable anatomy and structural suitability in both mandibular and limb salvage procedures [1, 3]. However, performing these harvests in skeletally immature patients requires careful consideration of the physis (the cartilaginous growth plate located at the ends of long bones), as surgical disruption can lead to progressive limb length discrepancies or angular deformities [4, 3]. While reconstructive surgery primarily focuses on flap survival and recipient site integration, long-term morbidity at the donor site remains a critical factor in the patient's overall quality of life [5]. A recent retrospective study examines the specific functional outcomes and donor-site complications unique to this pediatric population, offering actionable guidance for preoperative planning.