Pedicled fibular transfer for biologic knee extensor tendon reinsertion following proximal tibial resection in pediatric osteosarcoma: Long‐term outcomes

Abstract

Introduction: Proximal tibial sarcoma resections result in a reconstructive challenge, necessitating joint and extensor mechanism reconstruction. The gait and functional outcomes for children reconstructed with a combination of megaprosthesis and pedicled fibular flap for extensor mechanism reconstruction, are presented.Methods: Four patients, aged 11-18 years old, were available for comprehensive analysis. The proximal tibial osteosarcoma was resected, and the reconstructive technique involved a megaprosthesis for the knee joint, used in combination with a pedicled fibula flap as a biologic structure for reinsertion of the knee extensor mechanism. Outcomes were measured with three-dimensional gait analysis and patient questionnaires.Results: Minor postoperative wound issues occurred in some patients, requiring debridement with skin grafting. One patient fractured their transferred fibula, requiring fixation. The follow up period ranged from 1.7 to 24 years postoperatively. The longevity and quality of reconstructions were strong, measured by both objective and patient-reported outcomes. All patients reported independent walking >500 m in the Functional Mobility Scale and rated their walking as a nine or 10 (out of 10) on the Functional Assessment Questionnaire. Knee society scoring revealed overall satisfaction rate of 75-80%. No patients required gait aids. The gait profile analysis revealed effective gait patterns, with patterns deviating 5.4-7 from "typical gait." Deviations >6.5 are considered abnormal. Conclusion:The long-term results of combining a megaprosthesis with a pedicled fibula flap for extensor reinsertion, revealed a high level of independent function. The patients performed well, without the need for aids, and gait study evidence of minimal gait deviations.

Designing a better incision for proximal tibial osteosarcoma resection and reconstruction: a reminder of the skin's vascular anatomy

“…A recent review of our patients showed excellent medium‐ and long‐term outcomes, but an incidence of skin wound edge breakdown of 43% in the short term. Seven patients with adequate follow‐up had undergone this specific procedure, but three of those required early debridement and skin grafting onto the underlying gastrocnemius flap 3 . Whilst this delayed the recommencement of chemotherapy to a short extent, to our knowledge there have not been oncological repercussions from these delays.…”

“…The Alfred Hospital in Melbourne has the highest ECMO caseload in Australia. 3 As such, this heterogenous and complex group of patients form an important proportion of acute referrals to our vascular surgery department. Despite increasing worldwide experience in managing patients on ECMO, the appropriate algorithm for diagnosis and investigation of LLI for patients on ECMO is still poorly defined.…”