Lengthening in free vascularized fibular graft

A free vascularized fibular bone transfer was successfully performed in a 1 -year-old child to reconstruct the loss of the right humeral shaft followin g neonatal osteomyelitis. Subsequent growth of the child resulted in gross arm length discrepancy, with associated functional deficits. Callostatic di straction-lengthening of the vascularized fibular graft was carried out to compensate for this limb length discrepancy by using an Ilizarov external f ixator. Lengthening of 6 cm over a 3-month period, representing a 75% incre ase in the original length of the transplanted fibula, was achieved. Active bone regeneration, good corticalization and endosteal medullary cavity for mation was observed in the lengthened fibula. The combined modalities of va scularized bone transfer and Ilizarov callostatic distraction-lengthening o ffer a solution for reconstruction for large segmental bone loss associated with growth arrest of the epiphyseal plates in children.