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

Area of Science:

• Orthopedic Surgery
• Pediatric Oncology
• Limb Reconstruction

Background:

• Complex femoral defects pose significant challenges in limb salvage surgery.
• Previous reconstructions with allografts and chemotherapy led to recurrent infections and osteomyelitis in an adolescent.
• Segmental femoral loss resulted in thigh instability and risk of hip disarticulation.

Purpose of the Study:

• To present a novel vascularized rotational tibiaplasty technique for complex femoral defect reconstruction.
• To evaluate the efficacy of this method in restoring limb stability and function.
• To avoid hip disarticulation in a young patient with a compromised femur.

Main Methods:

• A 180° rotational vascularized tibiaplasty was performed, pivoting at the knee.
• The distal tibia was stabilized to the remaining proximal femur.
• This vascularized bone graft replaced the resected femur segment.

Main Results:

• The patient achieved a stable thigh and functional hip 10 years post-surgery.
• No evidence of recurrent infection or sarcoma was observed.
• A high Toronto Extremity Salvage Score (92.5) indicated minimal disability.

Conclusions:

• Vascularized rotational tibiaplasty provided a functional, biologic, and stable bone strut, mimicking the resected femur.
• This technique successfully obviated the need for allograft bone and preserved the hip joint.
• Rotational tibiaplasty is a feasible limb salvage option for complex femoral defects, potentially preventing amputation.