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Seu et al. Femoral head reconstruction in pediatric patient

A B

Figure 2: (A) Vascularized fibular autograft within cadaveric femoral allograft; (B) radiograph of final construct inset within patient’s hip

recreate the angle of the femoral neck, then secured double leg spica cast for hip joint immobilization.
within the trough of the cadaveric femoral allograft Her postoperative stay was uneventful and she
shell. The fibula extended out of the distal portion of was transferred to her local hospital on POD 18 for
the allograft shell to ensure intussusception, or bony continued care and management. She has had no
overlap within bone, into the native femoral diaphysis. complications at 6 months follow-up. Surveillance
The femoral allograft was reamed out to allow imaging has demonstrated good healing, maintenance
1.5 cm of intussusception and the distal aspect of the of the hip joint, and absence of local recurrence. She
autograft-allograft construct was malleted into the remains non-weight bearing and will begin physical
native femoral shaft. The native femoral head was therapy after the completion of her chemotherapy
modified to form a well-aligned cap to the proximal regimen. At 9 months follow-up, the patient presented
portion of the autograft-allograft complex. Terminally with no pain. X-rays demonstrated that the leg was
threaded Steinmann pins were used to hold the native healing well and that she could potentially advance her
femoral head cap and autograft-allograft complex weight bearing status [Figure 4].
together [Figure 2]. C-arm fluoroscopy was utilized
to ensure that the pins did not protrude outside the DISCUSSION
bone. The left hip was reduced into the acetabulum
and a 7-hole Synthes plate was placed to secure the
autograft-allograft complex with the native femoral Advancements in skeletal reconstruction have
shaft. C-arm fluoroscopy was used again to ensure improved options for limb salvage, but reconstruction
proper positioning of hardware in the construct. remains challenging when tumors occur in the joints
or epiphysis of children due to the need to preserve
[7]
The deep peroneal artery and vein were anastomosed both growth and durability . Most bone sarcomas are
in a retrograde fashion to the descending branch of localized to the metaphysis of the bone. In adults, the
the lateral femoral circumflex artery and vein [Figure 3]. entire proximal or distal portion of the bone is resected
[8]
A 2.5-mm coupler was used for venous anastomosis and reconstructed with prostheses . Diaphyseal bone
and 9-0 nylon suture was used to anastomose the defects can be reconstructed using megaprostheses
arteries end-to-end. The patient was secured in a and intercalary allografts, both of which have
posterior splint and an epidural was placed in the high rates of postoperative complications such as
operating room for postoperative pain management. nonunion, fracture, and infection [8-10] . However, the
Capanna technique can also be considered as a
The patient tolerated the procedure well without peri- method to reconstruct bony defects through the use
operative surgical or anesthetic complications. She of a vascularized autograft set within a decellularized
resumed her chemotherapy regimen immediately allograft, and has demonstrated positive outcomes in
after surgery and returned to the operating room variety of cases [11] . Though prostheses and allografts
on postoperative day (POD) 7 for placement of a can successfully reconstruct joints in adults, special

Plastic and Aesthetic Research ¦ Volume 4 ¦ November 30, 2017 211