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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

Intraoperative photographs. (Left) Before rotation, the vascularized tibiaplasty is shown with attached perfusion arteries and associated soft tissue. After amputation of the foot, excision of the fibula, and resection of the soleus and gastrocnemius muscles (middle), the tibia was rotated and internally fixed to the proximal femur (right).
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Figure 2: Intraoperative photographs. (Left) Before rotation, the vascularized tibiaplasty is shown with attached perfusion arteries and associated soft tissue. After amputation of the foot, excision of the fibula, and resection of the soleus and gastrocnemius muscles (middle), the tibia was rotated and internally fixed to the proximal femur (right).

Mentions: A lateral thigh incision for the recipient tibia was made through previous incisions, followed by an anterior midline longitudinal incision from the knee to the ankle. Medial and lateral fasciocutaneous flaps were elevated (Fig 2, left). The soleus and the gastrocnemius muscles were resected, and the fibula was excised. The anterior and lateral compartment muscles were carefully dissected off the tibia, leaving only the anterior tibial, posterior tibial, and peroneal arteries, and the surrounding soft tissues attached to the tibia. Distally, the dorsalis pedis, peroneal, and posterior tibial arteries and veins were dissected and ligated at the ankle. The foot was amputated at the tibiotalar joint, and the tibia was converted into a vascularized bone flap (Fig 2, middle). The popliteal artery and veins were dissected free at the distal thigh and the popliteal fossa.


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)

Intraoperative photographs. (Left) Before rotation, the vascularized tibiaplasty is shown with attached perfusion arteries and associated soft tissue. After amputation of the foot, excision of the fibula, and resection of the soleus and gastrocnemius muscles (middle), the tibia was rotated and internally fixed to the proximal femur (right).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Intraoperative photographs. (Left) Before rotation, the vascularized tibiaplasty is shown with attached perfusion arteries and associated soft tissue. After amputation of the foot, excision of the fibula, and resection of the soleus and gastrocnemius muscles (middle), the tibia was rotated and internally fixed to the proximal femur (right).
Mentions: A lateral thigh incision for the recipient tibia was made through previous incisions, followed by an anterior midline longitudinal incision from the knee to the ankle. Medial and lateral fasciocutaneous flaps were elevated (Fig 2, left). The soleus and the gastrocnemius muscles were resected, and the fibula was excised. The anterior and lateral compartment muscles were carefully dissected off the tibia, leaving only the anterior tibial, posterior tibial, and peroneal arteries, and the surrounding soft tissues attached to the tibia. Distally, the dorsalis pedis, peroneal, and posterior tibial arteries and veins were dissected and ligated at the ankle. The foot was amputated at the tibiotalar joint, and the tibia was converted into a vascularized bone flap (Fig 2, middle). The popliteal artery and veins were dissected free at the distal thigh and the popliteal fossa.

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