Iliac crest apophysis transfer to treat stump overgrowth after limb amputation in children: case series and literature review.

Abstract

Stump overgrowth is the main problem of limb amputation in children. Many surgical procedures have been developed to overcome the problem, but all have shown inconsistent results. The only surgical procedure that has been successful in preventing overgrowth is capping of the amputated limb with a cartilaginous cap taken from the amputated limb, usually from the head of fibula. A donor site is not available in revision cases. Iliac crest apophysis transfer was suggested to treat the condition, but has never been previously reported. The purpose of this study is to review the results of iliac crest apophysis transfer to prevent stump overgrowth. Five children with amputation stump overgrowth underwent iliac apophyseal transfer to cap the resection site of the overgrowth. Retrospective review showed that three of the five suffered recurrent stump overgrowth two to fouryears after the index surgery. All three were revised again. One patient was lost to follow-up. Although many studies showed capping of the stump with cartilaginous cap to be successful in preventing stump overgrowth, iliac crest apophysis transfer was only successful in one of four cases available to follow-up (25%). This is not a reliable enough method to be used routinely.