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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

Thirty months after surgery. There has been excellent healing of the right thigh with a functional hip joint (left). Anteroposterior radiographs show osteosynthesis of the distal tibia and proximal femur (middle) and the proximal tibia serving as the distal tip of the rotationplasty (right).
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Figure 3: Thirty months after surgery. There has been excellent healing of the right thigh with a functional hip joint (left). Anteroposterior radiographs show osteosynthesis of the distal tibia and proximal femur (middle) and the proximal tibia serving as the distal tip of the rotationplasty (right).

Mentions: The remnant distal femur was removed and disarticulated from the knee joint, which allowed the tibia to be rotated vertically. A soft tissue trough was created in the thigh, where the mid femur had been previously located. For proper length match, 10 cm of the distal tibia were removed. Osteosynthesis between the proximal femur and the distal tibia was achieved with an anterior internal 9-hole, 4.5-mm, narrow dynamic compression plate and a 5-hole, 4.5-mm, narrow dynamic compression plate (Synthes, West Chester, PA) placed 90° and lateral to the first plate (Fig 3, middle). The soft tissue defect was reconstructed with local muscle and tissue. Wounds were closed in multiple layers over 2 drains. The patient was discharged on postoperative day 11. She returned 2 months after surgery for an operative debridement of a small infected distal thigh seroma that grew Enterococcus faecalis. She was placed on intravenous and oral antibiotics.


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)

Thirty months after surgery. There has been excellent healing of the right thigh with a functional hip joint (left). Anteroposterior radiographs show osteosynthesis of the distal tibia and proximal femur (middle) and the proximal tibia serving as the distal tip of the rotationplasty (right).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Thirty months after surgery. There has been excellent healing of the right thigh with a functional hip joint (left). Anteroposterior radiographs show osteosynthesis of the distal tibia and proximal femur (middle) and the proximal tibia serving as the distal tip of the rotationplasty (right).
Mentions: The remnant distal femur was removed and disarticulated from the knee joint, which allowed the tibia to be rotated vertically. A soft tissue trough was created in the thigh, where the mid femur had been previously located. For proper length match, 10 cm of the distal tibia were removed. Osteosynthesis between the proximal femur and the distal tibia was achieved with an anterior internal 9-hole, 4.5-mm, narrow dynamic compression plate and a 5-hole, 4.5-mm, narrow dynamic compression plate (Synthes, West Chester, PA) placed 90° and lateral to the first plate (Fig 3, middle). The soft tissue defect was reconstructed with local muscle and tissue. Wounds were closed in multiple layers over 2 drains. The patient was discharged on postoperative day 11. She returned 2 months after surgery for an operative debridement of a small infected distal thigh seroma that grew Enterococcus faecalis. She was placed on intravenous and oral antibiotics.

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