Resections and Reconstructions in Skeletally Immature

This chapter examines the challenges and strategies for bone tumor resections and reconstructions in skeletally immature patients, where oncological safety must be balanced with preservation of growth and long-term function. It outlines the unique difficulties posed by open physes, small bone size, and the long duration reconstructions must endure, as well as the risks of leg-length discrepancies, multiple revisions, and psychosocial impact. The chapter reviews methods to predict growth disturbances, the effects of chemotherapy and radiotherapy on the physis, and their implications for surgical planning. Reconstructive options are comprehensively discussed, including expandable prostheses, biological methods such as allografts, vascularized fibular grafts, tumor-devitalized autografts, and allograft-prosthetic composites. Advanced approaches such as transepiphyseal resections and vascularized fibular epiphyseal transfers are highlighted for their potential to preserve joint function and growth. The outcomes, complications, and limitations of each technique are critically analyzed, with attention to functional recovery, durability, and quality of life. By integrating oncological, biological, and psychosocial considerations, this chapter provides a practical framework for tailoring treatment in children with bone sarcomas, offering strategies that accommodate growth while ensuring durable limb salvage.