Wide Resection, Extracorporeal Radiotherapy, Ipsilateral Vascularized Fibula Transposition, and Internal Fixation in a Case of Tibia Diaphyseal Ewing's Sarcoma

Abstract

A 24-year-old female patient was referred to our hospital with the diagnosis of Ewing's sarcoma localized in the left distal tibia. Neoadjuvant chemotherapy was completed for the patient who had localized disease. Enbloc resection of the tumor segment in the diaphyseal tibia, intraoperative extracorporeal radiotherapy, and then re-implantation of the segment after clearing the tumor were performed. Transfer of the ipsilateral pedicled fibula to the medulla of the irradiated segment was performed. As far as we know, the simultaneous application of extracorporeal radiotherapy and the re-implantation method after resection of the tibial tumoral segment and the transfer of the ipsilateral fibula with its pedicle has not been previously reported in the literature. In this case, this new technique was accompanied by a satisfactory result.

The Use of Free Fibula Flap in Different Extremities and Our Clinical Results

“…Vascular fibula grafts have very high bone fusion rates and can improve regional circulation, especially when the environment is damaged by chemotherapy and irradiation [ 16 ]. Minami et al reported an impressive series of free vascularized fibula transfers for reconstruction of long bones after bone excision using the fibula itself as the intercalary material [ 17 ].…”