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

Seu, Michelle; Haley, Allison; Cho, Samuel K.; Carl, Hannah M.; Bos, Tobias J.; Hassanein, Aladdin H.; Wong, Alison; Morris, Carol D.; Sacks, Justin M.

doi:10.20517/2347-9264.2017.47

Cited by 7 publications

(7 citation statements)

References 19 publications

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“… 10 , 14 One known case report performed a FVET and allograft technique in the proximal femur. 11 At the 9 months follow-up, the allograft had united; however, it did not seem the physis remained viable. It should be noted that the fibula was harvested on the peroneal vessel, which does not reliably vascularize the physis.…”

Section: Discussionmentioning

confidence: 98%

“… 1 , 5 - 7 Combined structural allografts and free fibula flaps can protect the fibula from facture and restore bone stock. 8 9 10 11 12 13 14 Here, we present a case of a pediatric proximal humeral reconstruction using the combination of a FVET and structural allograft with rotator cuff tendon after en bloc resection. Informed verbal consent was obtained from this patient's family before completion of this case report.…”

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confidence: 99%

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Composite-Free Vascularized Fibular Epiphyseal Flap and Proximal Humeral Allograft for Proximal Humerus Reconstruction in a Pediatric Patient

Houdek¹,

Wellings²,

Saifuddin³

et al. 2021

JAAOS Glob Res Rev

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Tumors involving the epiphysis in children present a reconstructive challenge. A free vascularized fibula epiphyseal transfer offers a means for biological reconstruction and longitudinal growth; however, it is often complicated by graft fracture and limited shoulder motion. Here, we present a case of a composite structural allograft with free vascularized fibula epiphyseal transfer for proximal humeral reconstruction. At 27-month follow-up, there was longitudinal growth, hypertrophy of the epiphysis, shoulder function which allowed activities of daily living, and no graft fracture.

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Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

Composite-Free Vascularized Fibular Epiphyseal Flap and Proximal Humeral Allograft for Proximal Humerus Reconstruction in a Pediatric Patient

Houdek¹,

Wellings²,

Saifuddin³

et al. 2021

JAAOS Glob Res Rev

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“…The three main growth areas in the proximal femur are the physeal plate, the growth plate of the greater trochanter, and the femoral neck isthmus. The proximal femoral physeal plate contributes to approximately 30% of the overall length of the femur, and 13% of the entire lower limb[ 13 ]. It is important to preserve joint function and activity if limb preservation can be expected, especially in pediatric patients who still have growth potential.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the small diameter of the femoral neck makes it challenging to obtain an appropriate proximal femoral allograft in this patient population. Re-implantation of the resected proximal femur bone post cryotherapy is another option to reinforce the biomechanical construct[ 13 ]. We used a folded autologous vascular fibula graft reconstructed from the proximal femur, particularly the femoral neck.…”

Section: Discussionmentioning

confidence: 99%

Resection with limb salvage in an Asian male adolescent with Ewing’s sarcoma: A case report

Lai¹,

Chen²,

Ho³

et al. 2022

WJCC

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BACKGROUND Ewing’s sarcoma is a highly malignant primary bone tumor that commonly affects children. For young patients, multidisciplinary treatment and limb salvage are recommended, and surgical plans considering the growth potential and bone activity after tumor resection are essential. CASE SUMMARY An 11-year-old Asian boy had a 1-mo history of a right-sided limping gait. Imaging revealed a proximal tumor with bone destruction and physeal involvement over the right femoral neck. He was diagnosed with stage IV (T1N0M1aG3) Ewing’s sarcoma with bilateral lung metastases. Neoadjuvant chemotherapy decreased the tumor size and confined it to the metaphyseal region. The patient underwent four stages of surgery: wide tumor excision plus reconstruction with vascular fibular bone graft plus internal fixation; repeat open reduction and internal fixation; femoral lengthening with orthosis after physeal maturity; and orthosis removal and bone elongation (approximately 6 cm). Following surgery, he could walk without discomfort and had almost equal-sized bilateral femoral heads, indicating physis preservation. The surgery was successful, and normal femoral head growth was achieved after complete remission. The patient was able to resume normal activities with equal length of the bilateral lower limbs. CONCLUSION Tumor treatment and reconstruction following resection are important in skeletally immature patients with Ewing’s sarcoma to improve quality of life.

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“…[ 4 ] However, in their case, the femoral head was replaced with the fibular head epiphysis. In a similar case by Seu et al,[ 5 ] the femoral head was preserved and the proximal femoral defect was reconstructed using the Capanna technique with a cadaveric femoral allograft.…”

Section: Discussionmentioning

confidence: 99%

Hip-preserving reconstruction of the proximal femur with a vascularized fibula autograft and liquid-nitrogen-treated tumor bearing bone

Ayvaz¹,

Göker

Leblebicioğlu³

2021

Jt Dis Relat Surg

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Primary bone malignancies in children pose numerus challenges for orthopedic oncology surgeons. Limb salvage surgery is widely preferred, and biological reconstruction methods such as the vascularized autografts, allografts, radiated or frozen tumor bearing autografts bear the advantage of preserving children's own anatomy. [1][2][3][4] In such cases, conserving the joint and epiphysis may potentially improve the outcome of otherwise debilitating surgeries. [1] In this article, we present a pediatric case of epiphysissparing biological reconstruction of the proximal femur. CASE REPORTA five-year-old male patient who had a twomonth-old history of inability to bear weight with the left lower extremity presented to our A five-year-old boy with Ewing sarcoma of the proximal femur was operated at our institution with limb-sparing surgery and biological reconstruction of the proximal femur with a vascularized fibular autograft. During this procedure, the proximal femur was soaked in liquid nitrogen which was subsequently fixed to the fibular autograft, while the epiphysis of the femoral head was spared. To the best of our knowledge, this is the first report of epiphysis-sparing surgery of the proximal femur via a vascularized fibular autograft surrounded by a liquid nitrogen-treated tumor bearing bone autograft. Three years postoperatively, the patient remains disease-free, has a full weight-bearing extremity with good function, and a remodeled proximal femur with minimal deformity. There are no radiological or clinical signs indicative of femoral head osteonecrosis. In conclusion, hip-sparing biological reconstruction is a successful method of limb preservation as an alternative to tumor endoprostheses.

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

Abstract: How to cite this article: Seu MY, Haley A, Cho BH, Carl HM, Bos TJ, Hassanein AH, Wong AL, Morris CD, Sacks JM. Proximal femur reconstruction using a vascularized fibular epiphysis within a cadaveric femoral allograft in a child with Ewing sarcoma: a case report. Plast

Cited by 7 publications

References 19 publications

Composite-Free Vascularized Fibular Epiphyseal Flap and Proximal Humeral Allograft for Proximal Humerus Reconstruction in a Pediatric Patient

Composite-Free Vascularized Fibular Epiphyseal Flap and Proximal Humeral Allograft for Proximal Humerus Reconstruction in a Pediatric Patient

Resection with limb salvage in an Asian male adolescent with Ewing’s sarcoma: A case report

Hip-preserving reconstruction of the proximal femur with a vascularized fibula autograft and liquid-nitrogen-treated tumor bearing bone

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