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Beitragstitel Proximal tibia resection for sarcoma: Reconstruction of the extensor mechanism using a free antero-lateral thigh perforator flap
Beitragscode P66
Autoren
  1. Carlo Theus-Steinmann Articon Spezialpraxis für Gelenkchirurgie Vortragender
  2. Georg Schelling Luzerner Kantonsspital & Swiss Sarcoma Network
  3. Mario Scaglioni Luzerner Kantonsspital (LUKS)
  4. Urs W. Müller Luzerner Kantonsspital
  5. Bruno Fuchs Luzerner Kantonsspital & Swiss Sarcoma Network
Präsentationsform Poster
Themengebiete
  • A07 - Spezialgebiet 3 | Tumore
Abstract Introduction
Bone sarcomas of the proximal tibia pose difficult challenges considering the resection of the patellar tendon and its restauration of function. There are several techniques used for the reconstruction of the extensor mechanism. Specifically, the goal is that the remainder of the patellar tendon stump is fixed to the prosthesis with the goal that it heals into the periprosthetic membrane to be able to power the leg. Most often, a gastrocnemius flap is used for soft tissue coverage. The disadvantage of using the medial gastrocnemius muscular head is the loss of power for foot flexion. In here, we report the use of a free antero-lateral thigh perforator flap (ALT) to obtain soft tissue coverage after extensive resections of the extensor musculature of the leg.

Methods
Two male (16 and 19yo) and one female (22yo) patients with two osteosarcomas and one Ewing’s sarcoma of the proximal tibia underwent a proximal tibia resection including extensive soft tissue removal of both extensors and flexors because of the local extent of the tumor. A tumor prosthesis was implanted, and the patellar tendon was fixed to the prosthesis in full extension. A free ALT was harvested from the ipsilateral thigh and anastomosed with the stumps of the anterior tibial vessels. In one patient, a large lymph vessel was anastomosed to the popliteal vein.

Results
All patients healed locally uneventfully. At a mean of 8-month follow-up, all three patients walked without crutches and had full active extension of the knee without lag, with normal push up from ground in the ankle.

Conclusion
The use of an ALT for coverage of the proximal tibia after extensive tumor resection has not been described yet. It can be safely used and allows to restore knee function without compromising the push-up power while walking.