Free tibia and fibula‐fillet‐of‐leg flap for pelvic ring reconstruction: A case report

Abstract

Pelvic sarcoma resections present large and complex defects, which are a challenge to reconstruct. At times, these cancers are treated with external hemipelvectomy, and both the soft tissue and bony framework of the pelvic ring must be addressed. The purpose of this case report is to describe the use of a free tibia and fibula‐fillet‐of‐leg flap for pelvic ring reconstruction, performed to enhance the quality of life of a patient following hemipelvectomy. A 50‐year‐old female with advanced stage undifferentiated pleomorphic sarcoma of the left thigh and pelvis underwent free vascularized tibia and fibula‐fillet‐of‐leg flap, including 21 cm of bone length and 21 cm long and full circumferential soft tissues of the leg, accompanying the bone, for the reconstruction of the bony pelvis and soft tissue. Postoperatively, the patient had no surgical complications, was followed for 6 months and went on to have bony healing, and was able to sit prior to disease progression and eventual death from metastatic disease. In the reported case, we have shown that composite tibia–fibula free flap with lower leg soft tissues may be a viable option for the reconstruction of massive external hemipelvectomy defects.

Pelvic ring reconstruction with double‐barreled fibular free flap: A systematic review

“…Recently, Sawyer et al reported a case of free tibia and fibula-fillet-of-leg flap for a bony and soft-tissue defect reconstruction after a complex hemipelvectomy. However, this option can be considered only for pelvic ring preservation in extremely challenging cases (Sawyer et al, 2020).…”