Proximal femur reconstruction using a vascularized fibular epiphysis within a cadaveric femoral allograft in a child with Ewing sarcoma: a case report

Abstract

Periarticular reconstruction of appendicular bones in skeletally immature patients after tumor resection is a surgical challenge that requires a multidisciplinary approach. The authors present a case of Ewing sarcoma of the proximal femur in an 8-year old girl treated with wide resection of the primary tumor and reconstruction using a vascularized fibula epiphyseal autograft within a cadaveric femoral allograft. The native femoral head was preserved to restore articular anatomy. Postoperative course was without complications. This report demonstrates the use of a vascularized fibula autograft within a cadaveric femoral allograft to optimize growth potential and joint durability in a pediatric patient.

Keywords

Femur reconstruction / vascularized fibula autograft / Ewing sarcoma

References

[1] Reed DR,Wagner L,Steppan DA,Shinohara ET,Loeb DM,Isakoff MS.Treatment pathway of bone sarcoma in children, adolescents, and young adults..Cancer2017;123:2206-18 PMCID:PMC5485018

[2] Weber KL.What's new in musculoskeletal oncology..J Bone Joint Surg Am2005;87:1400-10

[3] Starc MT,Meyers PA.Rare presentation of Ewing sarcoma metastasis to the sella and suprasellar cistern..Clin Imaging2016;41:73-7

[4] Yasko AW.Surgical management of primary bone sarcomas..Hematol Oncol Clin North Am1995;9:719-31

[5] Houdek MT,Stans AA,Bishop AT,Moran SL.What is the outcome of allograft and intramedullary free fibula (Capanna technique) in pediatric and adolescent patients with bone tumors?.Clin Orthop Relat Res2016;474:660-8 PMCID:PMC4746162

[6] Capanna RB.A new technique for reconstructions of large metadiaphiseal bone defects..Orthop Traumatol1993;3:159-77

[7] Dolen UC.Long term functional outcomes of the Capanna technique for pediatric limb salvage..Plast Reconstr Surg2012;130:90-1

[8] Ogura M,Sakuraba M,Chuman H.Intercalary reconstruction after wide resection of malignant bone tumors of the lower extremity using a composite graft with a devitalized autograft and a vascularized fibula..Sarcoma2015;2015:861575 PMCID:PMC4345269

[9] Muramatsu K,Tani Y,Taguchi T.Reconstruction of periacetabular bone tumor by vascularized fibula graft and irradiated autograft..Anticancer Res2009;29:1669-73

[10] Berrey BHJr,Gebhardt MC.Fractures of allografts. Frequency, treatment, and end-results..J Bone Joint Surg Am1990;72:825-33

[11] Capanna R,Belot N,Manfrini M,Ceruso M.A new reconstructive technique for intercalary defects of long bones: the association of massive allograft with vascularized fibular autograft. Long-term results and comparison with alternative techniques..Orthop Clin North Am2007;38:51-60

[12] Moran SL,Bishop AT.The use of massive bone allograft with intramedullary free fibular flap for limb salvage in a pediatric and adolescent population..Plast Reconstr Surg2006;118:413-9

[13] Hariri A,Atlan F,Heming N,Wicart P.Free vascularised fibular graft for reconstruction of defects of the lower limb after resection of tumour..J Bone Joint Surg Br2010;92:1574-9

[14] Manfrini M,Ceruso M.Original biological reconstruction of the hip in a 4-year-old girl..Lancet2003;361:140-2

[15] Innocenti M,Manfrini M,Capanna R.Vascularized proximal fibular epiphyseal transfer for distal radial reconstruction: surgical technique..J Bone Joint Surg Am2005;87:237-46

[16] Martin AL,Al-Dhamin A.Computed tomographic angiography for localization of the cutaneous perforators of the leg..Plast Reconstr Surg2013;131:792-800

[17] Wafa H.Surgical options and outcomes in bone sarcoma..Expert Rev Anticancer Ther2006;2:239-48

[18] Picci P,Rougraff BT,Casadei R.Relationship of chemotherapy-induced necrosis and surgical margins to local recurrence in osteosarcoma..J Clin Oncol1994;12:2699-705

[19] Canosa R.Effect of methotrexate in the biology of free vascularized bone grafts. A comparative experimental study in the dog..Clin Orthop Relat Res1994;301:291-301

[20] Taylor GI,Ham FJ.The free vascularized bone graft. A clinical extension of microvascular techniques..Plast Reconstr Surg1975;55:533-44

[21] Abed YY,Campanacci DA,Scoccianti G.Biological reconstruction after resection of bone tumours around the knee: long-term follow-up..J Bone Joint Surg Br2009;91:1366-72