TY - JOUR

T1 - Total calcaneal reconstruction using a massive bone allograft and a distally pedicled osteocutaneous fibula flap

T2 - A novel technique to prevent amputation after calcaneal malignancy

AU - Hamrouni, Nizar

AU - Højvig, Jens Hjermind

AU - Petersen, Michael Mørk

AU - Hettwer, Werner

AU - Jensen, Lisa Toft

AU - Bonde, Christian Torsten

N1 - Publisher Copyright: © 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons

PY - 2023

Y1 - 2023

N2 - In patients with primary calcaneal malignancies, such as Ewing's sarcoma, radical treatment with amputation of the foot can result in serious functional impairment and chronic pain. Total calcanectomy followed by the reconstruction of the calcaneal defect offers an alternative treatment to amputation. Capanna et al. described a technique for successfully reconstructing long limb segmental bone defects using a free fibula flap placed within the intramedullary canal of an allograft. We present both a review of the literature on calcaneal reconstruction and describe how the principles of Capanna can be adapted to reconstruct the calcaneus. Total calcanectomy due to Ewing's sarcoma and the subsequent application of this novel reconstructive technique was performed in two young patients aged 5 and 16 years. The reconstruction was achieved by inserting a distally pedicled osteocutaneous fibula flap within the reamed canal of an allograft and placing the composite in the calcaneal defect. Reconstruction was successful with complete bone union between the allograft and the adjacent bone. There were no fractures or infections and both flaps survived. Functional outcome was assessed with a physiotherapist at a follow-up period of 2 years postoperatively, showing near-normal ambulance. This novel technique proved excellent as a limb salvage procedure, avoiding amputation, and offering a satisfactory oncological and functional outcome.

AB - In patients with primary calcaneal malignancies, such as Ewing's sarcoma, radical treatment with amputation of the foot can result in serious functional impairment and chronic pain. Total calcanectomy followed by the reconstruction of the calcaneal defect offers an alternative treatment to amputation. Capanna et al. described a technique for successfully reconstructing long limb segmental bone defects using a free fibula flap placed within the intramedullary canal of an allograft. We present both a review of the literature on calcaneal reconstruction and describe how the principles of Capanna can be adapted to reconstruct the calcaneus. Total calcanectomy due to Ewing's sarcoma and the subsequent application of this novel reconstructive technique was performed in two young patients aged 5 and 16 years. The reconstruction was achieved by inserting a distally pedicled osteocutaneous fibula flap within the reamed canal of an allograft and placing the composite in the calcaneal defect. Reconstruction was successful with complete bone union between the allograft and the adjacent bone. There were no fractures or infections and both flaps survived. Functional outcome was assessed with a physiotherapist at a follow-up period of 2 years postoperatively, showing near-normal ambulance. This novel technique proved excellent as a limb salvage procedure, avoiding amputation, and offering a satisfactory oncological and functional outcome.

KW - Calcaneal reconstruction

KW - Fibula flap

KW - Heel

KW - Lower limb

KW - Microsurgery

KW - Oncology

KW - Orthoplastic approach

KW - Pediatric

KW - Pedicled flap

KW - Reconstruction

KW - Sarcoma

U2 - 10.1016/j.bjps.2022.10.039

DO - 10.1016/j.bjps.2022.10.039

M3 - Journal article

C2 - 36516510

AN - SCOPUS:85143666687

VL - 76

SP - 44

EP - 48

JO - Journal of plastic, reconstructive & aesthetic surgery : JPRAS

JF - Journal of plastic, reconstructive & aesthetic surgery : JPRAS

SN - 1748-6815

ER -