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Case Reports
. 2016 Nov 18;14(1):291.
doi: 10.1186/s12957-016-1037-8.

Simultaneous reconstruction of the bone and vessels for complex femoral defect

Shimpei Miyamoto  1 , Masahide Fujiki  2 , Nokitaka Setsu  3 , Akira Kawai  3
Affiliations
Case Reports

Simultaneous reconstruction of the bone and vessels for complex femoral defect

Shimpei Miyamoto et al. World J Surg Oncol. .

Abstract

Background: Several methods have been reported for intercalary reconstruction of femoral defects. Of these, free vascularized fibula grafts (FVFG) are preferred because of their durability, bone-healing potential, and tolerance to infection. If the bone tumor invades the femoral vessels, simultaneous vascular reconstruction also becomes necessary and significant technical hurdles make limb salvage difficult.

Case presentation: We present a 10-year-old girl who underwent limb-sparing surgery for a distal femur osteosarcoma. The femoral defect was 15 cm long, and the femoral vessel defect was 10 cm long. The femur was reconstructed with bilateral FVFG, and the femoral vessels were reconstructed with saphenous vein grafts. The grafts survived without vascular compromise, and the affected limb was preserved successfully.

Conclusions: Combined use of bilateral FVFG and autologous vein grafts makes limb-sparing surgery for a large osteosarcoma of the femur possible.

Keywords: Bypass flap; Flow-through; Lateral circumflex femoral; Popliteal artery; Revascularization.

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Figures

Fig. 1
Fig. 1
Preoperative contrast-enhanced magnetic resonance image. a Coronal view. b Axial view. Superficial femoral vessels (arrow)
Fig. 2
Fig. 2
Intraoperative appearance after reconstruction of the superficial femoral artery and vein (arrows). Left side is craniad
Fig. 3
Fig. 3
Intraoperative appearance after transfer of the bilateral FVFG. Left side is craniad. left fibula (black arrows), right fibula (white arrows), and monitoring flap of the right fibula (arrow heads)
Fig. 4
Fig. 4
Appearance after 1 year
Fig. 5
Fig. 5
Postoperative X-ray obtained after 20 months shows complete bone union
See this image and copyright information in PMC

References

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