Pediatric extremity bone sarcoma reconstruction with the vascularized fibula flap: Observational study assessing long-term functional outcomes, complications, and survival.

BACKGROUND: Limb salvage is important in pediatric patients with bone sarcomas. The vascularized fibula flap is a versatile option, combined or not with a bone allograft. The authors evaluated the functional long-term outcomes, complications, and survival of using this technique in pediatric patients. METHODS: A retrospective review of 27 pediatric patients reconstructed between 2011 and 2018 with the fibula flap after bone sarcoma resection was conducted. Long-term functional outcomes, complications, and survival were assessed. Variables analyzed were age, sex, Capanna technique, follow-up, complications, additional surgeries, time to weight bearing, length discrepancy, and sport practice. RESULTS: Twenty-seven patients with a mean age of 9.3 years were included. The mean follow-up was 44.33 months. The Capanna technique was performed in 15 patients. All extremities but one were salvaged. The overall complication rate was 74.07%. Fibula fracture and nonunion rates were 34.04% and 11.11%, respectively. Partial weight bearing was resumed at a mean of 9.07 months. About 79.17% of patients with a 12-month follow-up achieved full weight bearing. An age below 8 years was significantly associated with a lower major complication rate and a shorter time to weight bearing and full weight bearing. Major complications and additional surgeries were significantly associated with longer periods until weight bearing and full weight bearing. CONCLUSIONS: The fibula flap allows the majority of extremities to be reconstructed. However, a high rate of complications and additional surgeries should be anticipated. Full weight bearing is usually achieved within the first year, with modest functional increase afterward. Less complications and a faster functional recovery are expected in patients below the age of 8 years.

Gains to species diversity in organically farmed fields are not propagated at the farm level.

Organic farming is promoted to reduce environmental impacts of agriculture, but surprisingly little is known about its effects at the farm level, the primary unit of decision making. Here we report the effects of organic farming on species diversity at the field, farm and regional levels by sampling plants, earthworms, spiders and bees in 1470 fields of 205 randomly selected organic and nonorganic farms in twelve European and African regions. Species richness is, on average, 10.5% higher in organic than nonorganic production fields, with highest gains in intensive arable fields (around +45%). Gains to species richness are partly caused by higher organism abundance and are common in plants and bees but intermittent in earthworms and spiders. Average gains are marginal +4.6% at the farm and +3.1% at the regional level, even in intensive arable regions. Additional, targeted measures are therefore needed to fulfil the commitment of organic farming to benefit farmland biodiversity.

Herbivore effects on developmental instability and fecundity of holm oaks.

Plants are able to compensate for loss of tissue due to herbivores at a variety of spatial and temporal scales, masking detrimental effects of herbivory on plant fitness at these scales. The stressing effect of herbivory could also produce instability in the development of plant modules, and measures of such instability may reflect the fitness consequences of herbivory if instability is related to components of plant fitness. We analyse the relationships between herbivory, developmental instability and production of female flowers and fruits of holm oak Quercus ilex trees by means of herbivore removal experiments. Removal of leaf herbivores reduced herbivory rates at the tree level, but had no effect on mean production of female flowers or mature fruits, whereas herbivory tended to enhance flower production and had no effect on fruit abortion at the shoot level. Differences in herbivory levels between shoots of the same branch did not affect the size and fluctuating asymmetry of intact leaves. These results indicate compensation for herbivory at the tree level and over-compensation at the shoot level in terms of allocation of resources to female flower production. Removal of insect herbivores produced an increase in the mean developmental instability of leaves at the tree level in the year following the insecticide treatment, and there was a direct relationship between herbivory rates in the current year and leaf fluctuating asymmetry the following year irrespective of herbivore removal treatment. Finally, the production of pistillate flowers and fruits by trees was inversely related to the mean fluctuating asymmetry of leaves growing the same year. Leaf fluctuating asymmetry was thus an estimator of the stressing effects of herbivory on adult trees, an effect that was delayed to the following year. As leaf fluctuating asymmetry was also related to tree fecundity, asymmetry levels provided a sensitive measure of plant performance under conditions of compensatory responses to herbivory.

Fruit abortion, developmental selection and developmental stability in Quercus ilex.

Fruit abortion has been hypothesized to be a parental means of selective removal of propagules with low viability. In particular, aborted zygotes have been suggested to have developmentally deviant phenotypes, and surviving offspring may therefore give rise to adults with a developmentally stable phenotype. We tested predictions from this hypothesis using acorns of holm oaks Quercus ilex as a model system. Fecundity of oak trees was negatively related to mean fluctuating asymmetry of leaves, and abortion rates were positively related to leaf fluctuating asymmetry in at least one population. Aborted acorns were asymmetric in 83-99% of cases in three samples, while mature acorns were only asymmetric in 57-78% of cases. Acorn asymmetry was unrelated to germination probability and germination date, and had no significant effect on number of leaves, leaf mass, stem mass, seedling height or leaf area of seedlings. However, acorn asymmetry affected the trade-off between number and size of leaves in seedlings. Seedlings from asymmetric acorns showed a positive relationship between acorn size and number of leaves, but no relationships between acorn size and leaf area, while symmetric acorns showed the opposite. A positive relationship between acorn size and number of leaves in spring was found for naturally emerged seedlings that died during their first summer, whereas the number of leaves produced by surviving seedlings did not depend on acorn size. These findings are consistent with the hypothesis that stressed trees selectively abort propagules of low viability, and that developmental selection acts on a measure of developmental instability of fruits.