Pedicle scapular apophysis transplantation in congenital limb malformations.

Congenital segmental amputations are difficult to correct. Free interposition bone grafts with growth centers were tried experimentally by many investigators even at the beginning of this century. Attempts at clinical application of this principle, however, were mostly failures. More recently, with the advent of microsurgical techniques, new hope has arisen. In particular, toe transfers in children have confirmed the survival of such growth centers, as these transfers could be found to grow normally [1]. The transfer of vascularized epiphysis with its growth plate has been shown in animal limbs to achieve a rate of growth comparable with the normal site. Originally, two donor sites were used with acceptable results in children. These were the superior epiphysis of the fibula and the iliac crest. So far, in most clinical applications, they have been used as appositional transfers. However, a growth problem occurring at the donor site has proved to be quite crippling.