Entire calcaneus reconstruction with pedicled composite fibular growth plate flap in a pediatric patient

3D-Printed Modular Endoprosthesis Reconstruction Following Total Calcanectomy in Calcaneal Malignancy

BACKGROUND

The use of 3D-printed endoprosthesis has been proposed as a viable limb-salvage procedure following total calcanectomy in patients with calcaneal malignancy. However, certain drawbacks persist concerning the prosthetic design. In this case series, we designed a modular endoprosthesis incorporating a novel drainage system, aiming to improve the functional outcomes and to promote wound healing.

METHODS

We retrospectively analyzed patients with calcaneal malignancy who underwent 3D-printed modular endoprosthesis reconstruction. Clinically, we evaluated functional outcomes using the 10-cm visual analog scale (VAS) score, the 1993 version of the Musculoskeletal Tumor Society (MSTS-93) score, and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Complications were also recorded.

RESULTS

Five male patients met the final inclusion criteria. The median age was 20 years (range 13-47 years). The median follow-up time was 28 months (range, 13-65 months). Median postoperative functional MSTS-93, VAS, and AOFAS scores were 27 points (range, 25-29), 0 points (range, 0-1), and 86 points (range, 83-93), respectively. Wound healing was observed in all patients, and there were no complications related to the endoprosthesis at the last follow-up.

CONCLUSION

The use of 3D-printed modular endoprosthesis was associated with satisfactory short-term outcomes in patients undergoing calcaneal reconstruction. The incorporation of a novel design featuring an integrated draining system has the potential to enhance wound healing and expedite functional recovery.

LEVEL OF EVIDENCE

Level IV, case series.

Vascularized Fibular Epiphyseal Transfer for Pediatric Limb Salvage: Review of Applications and Outcomes

Vascularized fibular epiphyseal transfer (VFET) offers a functional advantage in pediatric limb salvage due to the preservation of growth potential and an articular surface for remodeling. This review summarizes the available evidence on the clinical characteristics and outcomes of pediatric reconstruction applying VFET at different recipient sites and with varying techniques. VFET was used to reconstruct the proximal humerus, distal radius or ulna, proximal femur, distal fibula, calcaneus, and mandible. Although most often harvested on the anterior tibial artery, VFET has also been performed using the peroneal artery, the inferior lateral genicular artery, and a dual pedicle. Recipient site flap inset most often involved fixation with plates and/or screws as well as soft tissue reconstruction using a retained slip of biceps femoris tendon. Outcomes included limb growth, range of motion, and strength. The most common reported complications were bone flap fracture and peroneal nerve palsy. The anterior tibial artery was the most applied pedicle with reliable limb growth, but with the added risk of postoperative peroneal palsy. Bone flap fracture most often occurred at the proximal humerus and femur recipient sites. Plate fixation and the combined use of allograft had lower instances of bone flap fracture. This review highlights how the anticipated dynamic growth and remodeling this free flap offers in the long term must be weighed against its complexity and potential complications.

Double vascularized fibula growth plate transfer for the reconstruction of long segmental tibia in pediatric patients: Report of three cases

Osteosarcoma is a common bone tumor for pediatric patients that has a complex treatment including chemotherapy and radical surgical resection. There are few functional leg reconstruction possibilities described in the literature for pediatric patients due to limited growth potential. The aim of this report is to show long-term results using double vascularized growth plate flaps for the long segmental tibial reconstruction in growing children with satisfactory functionality and preserved limb growth without the use of permanent foreign materials. Three patients with sarcoma in the proximal part of the tibial bone were treated with complex therapy that included preoperative chemotherapy, radical resection of proximal metaepiphysis with tibial growth plate and half of the diaphysis and transplantation of double fibula growth plate flaps-the pedicled ipsilateral and the contralateral as a microvascular flap. The first patient, a male, 13 year with periosteal sarcoma, underwent 17 cm tibial resection with transplantation of the ipsilateral fibula 20 cm and contralateral fibula 20.1 cm, and continued follow-up for 6 years. The second patient, a male, 6 years of age with osteosarcoma, had 14 cm tibial resection with 16 cm ipsilateral and 16.1 cm contralateral fibular transplantation, continued follow-up for 5 years. The third patient, a female, 12 years of age with osteosarcoma, underwent 14 cm tibial resection with 15.4 cm ipsilateral and 15.9 cm contralateral fibular transplantation, and current follow-up of 1 year. Double fibular growth plate transfer is limb-sparing method for a proximal tibial reconstruction with natural growth potential for the pediatric patients.

Heel reconstruction with ALT free flap in a 4-year-old patient after a severe lawnmower injury. A case report

Lawnmowers represent a danger in pediatric population. Frequently, traumas involve limbs. Among the different reconstructive techniques, a free flap is often needed. We discuss the first case of heel reconstruction with an anterolateral thigh flap in a 4-years-old patient after a lawnmower's trauma.