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Updated: Feb 18, 2026
Surgical Angiogenesis in Porcine Tibial Allotransplantation: A New Large Animal Bone Vascularized Composite Allotransplantation Model
Published on: August 13, 2017
A-Frame free Vascularized Fibular Graft and Femoral Lengthening for Osteosarcoma Pediatric Patients
Megan Cashin1, Christopher Coombs2, Ian Torode2
1Department of Orthopaedic Surgeon, University of Western Ontario, London, ON, Canada.
Background:
Pediatric limb reconstruction after resection of a malignant tumor presents specific challenges. Multiple surgical techniques have been used to treat these patients. This paper describes a staged surgical technique for the reconstruction of large distal femoral defects due to tumor resection in skeletally immature patients.
Methods:
Three pediatric patients with osteosarcoma of the distal femur underwent staged reconstruction. Neoadjuvant chemotherapy was followed by en bloc tumor resection and immediate reconstruction of the distal femoral defect with a vascularized free fibular autograft utilizing a unique A-frame construct combined with intramedullary nail fixation. The second stage was a planned gradual lengthening of the healed construct, over a custom-made magnetically driven expandable intramedullary nail.
Results:
All patients achieved bony union and satisfactory length with minimal complications. The patients all returned to full, unlimited physical activities.
Conclusions:
The early results confirm that the described technique is a safe and reliable procedure for the reconstruction of large femoral defects in pediatric patients with osteosarcoma.
Level Of Evidence:
Level IV-therapeutic.
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