Reconstruction of distal tibial defects following resection of malignant tumours by ipsilateral pedicled vascularized fibular graft and ankle arthrodesis

ABSTRACT

The aim of the work was to evaluate the oncologic and functional outcome after wide resection of malignant tumours of the distal tibia and reconstruction of the defect by ipsilateral pedicled vascularized fibular graft and ankle arthrodesis. 13 Patients with primary malignant tumours of the distal tibia were treated by wide resection. The histological diagnosis was osteosarcoma in 11 cases and Ewing's sarcoma in 2 cases. All patients received neoadjuvant chemotherapy. There were 9 males and 4 females. The mean age of the patients at the time of surgery was 15 years. The fibula was mobilized to fill the defect pedicled on the peroneal vessels. The average size of the defects reconstructed was 10cms. Patients were evaluated functionally using the Musculoskeletal tumor society evaluation system. The average time of the operation was 3 hours. Chest metastases developed in 4 patients and local recurrence in one patient. The mean duration of follow up was 27 months. The mean functional score was 80% at the time of last follow-up. The average time of union of the graft both proximally and distally was 6 months. Complications included superficial infection [2 patients], stress fracture [1 patient], non union [2 patients], varus angulation [2 patients] and limb length discrepancy [9 patients]. Reconstruction of distal tibial defects by the ipsilateral pedicled vascularized fibular graft is a technically easy reconstructive option which offers a predictable long st and ing functional outcome that is comparable, if not better, than that achieved with allografts and prosthetic reconstructions