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CASE REPORT Rotational Vascularized Tibiaplasty After Oncologic Resection and Major Wound Healing Problems: A Novel Technique.

Schubert CD, Frassica FJ, Attar S, Deune EG - Eplasty (2013)

Bottom Line: The distal tibia was internally stabilized to the residual proximal femur.In this patient, the tibial rotationplasty provided a vascularized bone strut mimicking the resected femur; saved the hip; obviated an allograft bone; and created a functional, biologic, stable, and durable thigh that allowed full weight bearing on a prosthesis, with a low physical disability level.We conclude that, for patients with complex femoral defects, a vascularized rotational tibiaplasty should be considered a feasible option before amputation.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Md.

ABSTRACT

Objective: To describe a novel method to reconstruct, with a vascularized rotational tibiaplasty, a complex femoral defect in an adolescent.

Methods: After a femoral osteosarcoma resection, allograft reconstruction, and chemotherapy, an 11-year-old girl developed recurrent thigh wound infections and femoral allograft osteomyelitis despite multiple operative interventions. At the age of 13, she presented to our center with a complex right thigh wound and an unstable lower extremity secondary to a segmental femoral loss. To reestablish thigh stability and function and to avoid amputation at the hip, the authors performed a rotational vascularized tibiaplasty. The tibia was rotated 180° with the pivot at the knee. The distal tibia was internally stabilized to the residual proximal femur.

Results: Ten years later, the patient had a stable thigh, a functional hip, no evidence of infection or sarcoma, and a Toronto Extremity Salvage Score of 92.5 (minimal disability).

Conclusions: In this patient, the tibial rotationplasty provided a vascularized bone strut mimicking the resected femur; saved the hip; obviated an allograft bone; and created a functional, biologic, stable, and durable thigh that allowed full weight bearing on a prosthesis, with a low physical disability level. We conclude that, for patients with complex femoral defects, a vascularized rotational tibiaplasty should be considered a feasible option before amputation.

No MeSH data available.


Related in: MedlinePlus

Clinical preoperative images. (Top) Extensive scarring. (Bottom left) An unstable thigh with 90° of dorsal extension in the distal thigh secondary to the lack of an intact femur. The thigh is freely mobile to deforming forces. Anteroposterior radiographs of the right hip (bottom, middle) and the right knee joint (bottom, right) display the major bony defect.
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Figure 1: Clinical preoperative images. (Top) Extensive scarring. (Bottom left) An unstable thigh with 90° of dorsal extension in the distal thigh secondary to the lack of an intact femur. The thigh is freely mobile to deforming forces. Anteroposterior radiographs of the right hip (bottom, middle) and the right knee joint (bottom, right) display the major bony defect.

Mentions: An 11-year-old girl with a right femoral osteosarcoma underwent resection, adjuvant chemotherapy, and immediate reconstruction with an allograft femur and a rectus abdominis free flap at another institution. Her postoperative course was complicated by persistent wound infections and allograft osteomyelitis. She presented to the authors’ institution at the age of 13 with a complex right thigh wound and an unstable lower extremity (Fig 1). The allograft femur was removed and replaced with a tobramycin-impregnated cement spacer. She subsequently underwent intramedullary rodding with methyl methacrylate, placement of an Ilizarov external fixator, and placement of a cortical strut allograft bone to the proximal femur. She again developed purulent drainage, requiring additional debridements and fixator removal. All additional attempts of lengthening were abandoned. To avoid allograft tissue placement, further infections, or amputation at the hip and to re-establish a stable, functional thigh, the authors performed a rotational vascularized autologous tibiaplasty. We discussed the operative plans in great detail with the patient and her parent, and they decided to proceed with the reconstructive attempt.


CASE REPORT Rotational Vascularized Tibiaplasty After Oncologic Resection and Major Wound Healing Problems: A Novel Technique.

Schubert CD, Frassica FJ, Attar S, Deune EG - Eplasty (2013)

Clinical preoperative images. (Top) Extensive scarring. (Bottom left) An unstable thigh with 90° of dorsal extension in the distal thigh secondary to the lack of an intact femur. The thigh is freely mobile to deforming forces. Anteroposterior radiographs of the right hip (bottom, middle) and the right knee joint (bottom, right) display the major bony defect.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750817&req=5

Figure 1: Clinical preoperative images. (Top) Extensive scarring. (Bottom left) An unstable thigh with 90° of dorsal extension in the distal thigh secondary to the lack of an intact femur. The thigh is freely mobile to deforming forces. Anteroposterior radiographs of the right hip (bottom, middle) and the right knee joint (bottom, right) display the major bony defect.
Mentions: An 11-year-old girl with a right femoral osteosarcoma underwent resection, adjuvant chemotherapy, and immediate reconstruction with an allograft femur and a rectus abdominis free flap at another institution. Her postoperative course was complicated by persistent wound infections and allograft osteomyelitis. She presented to the authors’ institution at the age of 13 with a complex right thigh wound and an unstable lower extremity (Fig 1). The allograft femur was removed and replaced with a tobramycin-impregnated cement spacer. She subsequently underwent intramedullary rodding with methyl methacrylate, placement of an Ilizarov external fixator, and placement of a cortical strut allograft bone to the proximal femur. She again developed purulent drainage, requiring additional debridements and fixator removal. All additional attempts of lengthening were abandoned. To avoid allograft tissue placement, further infections, or amputation at the hip and to re-establish a stable, functional thigh, the authors performed a rotational vascularized autologous tibiaplasty. We discussed the operative plans in great detail with the patient and her parent, and they decided to proceed with the reconstructive attempt.

Bottom Line: The distal tibia was internally stabilized to the residual proximal femur.In this patient, the tibial rotationplasty provided a vascularized bone strut mimicking the resected femur; saved the hip; obviated an allograft bone; and created a functional, biologic, stable, and durable thigh that allowed full weight bearing on a prosthesis, with a low physical disability level.We conclude that, for patients with complex femoral defects, a vascularized rotational tibiaplasty should be considered a feasible option before amputation.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Md.

ABSTRACT

Objective: To describe a novel method to reconstruct, with a vascularized rotational tibiaplasty, a complex femoral defect in an adolescent.

Methods: After a femoral osteosarcoma resection, allograft reconstruction, and chemotherapy, an 11-year-old girl developed recurrent thigh wound infections and femoral allograft osteomyelitis despite multiple operative interventions. At the age of 13, she presented to our center with a complex right thigh wound and an unstable lower extremity secondary to a segmental femoral loss. To reestablish thigh stability and function and to avoid amputation at the hip, the authors performed a rotational vascularized tibiaplasty. The tibia was rotated 180° with the pivot at the knee. The distal tibia was internally stabilized to the residual proximal femur.

Results: Ten years later, the patient had a stable thigh, a functional hip, no evidence of infection or sarcoma, and a Toronto Extremity Salvage Score of 92.5 (minimal disability).

Conclusions: In this patient, the tibial rotationplasty provided a vascularized bone strut mimicking the resected femur; saved the hip; obviated an allograft bone; and created a functional, biologic, stable, and durable thigh that allowed full weight bearing on a prosthesis, with a low physical disability level. We conclude that, for patients with complex femoral defects, a vascularized rotational tibiaplasty should be considered a feasible option before amputation.

No MeSH data available.


Related in: MedlinePlus