Lower extremity reconstruction after limb-sparing sarcoma resection of the proximal tibia in the pediatric population

Case series, with algorithm

Jon P. Ver Halen, Miguel A. Soto-Miranda, Sarah Hammond, Petros Konofaos, Mike Neel, Bhaskar Rao

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Limb salvage surgery (LSS) is the current treatment of choice for bone sarcomas in children. These procedures require composite resection and reconstruction, and are subject to high functional demands. Proximal tibia tumours, in particular, pose a significant challenge to treatment and reconstruction. A retrospective review was performed of all patients undergoing resection of proximal tibia bone sarcomas at a single centre over a 12-year period. Twenty-one patients (14 male, seven female) with an average age of 14.4 years (range = 8.3-19.2 years) underwent resection of a proximal tibial sarcoma. Pathology included osteosarcoma (OS) in 16, and Ewing's sarcoma family of tumours (ESFT) in five. Seventeen patients had bone tumour reconstruction with modular endoprsothesis, one patient with allograft, and three patients with an expandable endoprosthesis. One patient had primary closure; 20 patients had combined gastrocnemius and soleus flap reconstruction; three patients required subsequent bipedicled flap reconstruction, and two patients required subsequent sural artery flap reconstruction. No patients required free flap reconstruction. The average length of tibial osteotomy was 15 cm (range = 12.7-22.5 cm). Median soft tissue mass volume resected was 293 cm(range = 211-1141 cm3). Median follow-up was 2.8 years (range = 0.5-6.8 years). Two patients died from metastatic disease. Two patients ultimately required amputation. Nineteen patients were ambulatory at last follow-up. This study presents an algorithm for soft-tissue reconstruction after resection of bone sarcomas of the proximal tibia. These techniques minimise complications, and maximise function in the paediatric population.

Original languageEnglish (US)
Pages (from-to)238-243
Number of pages6
JournalJournal of Plastic Surgery and Hand Surgery
Volume48
Issue number4
DOIs
StatePublished - Jan 1 2014

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Tibia
Sarcoma
Lower Extremity
Extremities
Pediatrics
Population
Bone and Bones
Neoplasms
Limb Salvage
Ewing's Sarcoma
Free Tissue Flaps
Osteosarcoma
Osteotomy
Amputation
Allografts
Arteries
Pathology

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Lower extremity reconstruction after limb-sparing sarcoma resection of the proximal tibia in the pediatric population : Case series, with algorithm. / Ver Halen, Jon P.; Soto-Miranda, Miguel A.; Hammond, Sarah; Konofaos, Petros; Neel, Mike; Rao, Bhaskar.

In: Journal of Plastic Surgery and Hand Surgery, Vol. 48, No. 4, 01.01.2014, p. 238-243.

Research output: Contribution to journalArticle

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