Abstract
The case of a seven-year-old boy with a Ewing’s sarcoma of the humerus diaphysis extending into the epiphysis proximally. He underwent chemotherapy followed by 12 cm resection of the proximal humerus with preservation of rotator cuff. Reconstruction was performed using a 15 cm vascularized fibula epiphyseal transfer raised using a postero-lateral approach based on the peroneal artery and its venae commitans. The common peroneal nerve was protected proximally and all motor branches were preserved. The pedicle length was 7cm. When isolated on the peroneal artery, bleeding was seen at the level of the epiphysis and periosteum of the fibula head.
Highlights
We report the case of a seven-year-old boy with a Ewing’s sarcoma of the humerus diaphysis extending into the epiphysis proximally
A CT scan performed at 18 months postoperation showed the proximal fibular epiphysis had remained open, demonstrated on plain film x-ray
This study showed that the peroneal artery supplied the epiphysis through periosteal vessels and the ascending branch of the nutrient artery
Summary
We report the case of a seven-year-old boy with a Ewing’s sarcoma of the humerus diaphysis extending into the epiphysis proximally. He underwent chemotherapy followed by 12 cm resection of the proximal humerus with preservation of rotator cuff. Reconstruction was performed using a 15 cm vascularized fibula epiphyseal transfer This was raised using a postero-lateral approach based on the peroneal artery and its venae commitans. The epiphysis of the fibula was placed in the glenoid fossa and the Murphy and Coombs: Fibular epiphyseal transfer: the peroneal vessels revisited. A CT scan performed at 18 months postoperation (for oncological surveillance) showed the proximal fibular epiphysis had remained open, demonstrated on plain film x-ray (figures 3a and 3b).
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