Limb salvage surgery for malignant tumors of the proximal tibia involving the fibula

Abstract

Objective To investigate technique,effect,complications of limb salvage surgery for malignant tumors of the proximal tibia involving the fibula.Methods Between November 1998 and February 2010,32 patients with malignant tumors of the proximal tibia involving the fibula underwent limb salvage surgery in our institute.There were 21 males and 11 females,aged from 10 to 66 years (average,23.4years).There were 23 cases of osteosarcoma,5 cases of chondrosarcoma,1 case of malignant giant cell tumor,and 3 cases of soft tissue sarcoma.All patients received en bloc resection of tumor including proximal tibia and fibula.During operations,ligation of anterior tibial vessels was performed in 14 patients,anastomosis of posterior tibial vessels in 1 patient,both ligation of anterior tibial vessels and anastomosis or replacement of posterior tibial vessels in 5 patients.The common peroneal nerve was resected in 4 patients,and the deep peroneal nerve was resected in 5 patients.The reconstruction methods included prosthetic replacement in 24 patients,replacement with inactivated autograft-prosthesis composite in 5 patients,and replacement with inactivated autograft in 3 patients.The caput mediale musculi gastrocnemii flap was transferred to reconstruct soft tissue defect in 14 patients,while caput laterale musculi gastrocnemii flap was transferred in 1patient.Results All patients were followed up for 11 to 159 months (average,39.4 months).Local recurrence occurred in 6 patients (18.8％).The overall 5-year survival rate was 51.2％.Fourteen patients died of tumor metastasis,2 survived with tumor,and 16 patients survived without tumor.Variant complications occurred in 15 patients (46.9％).The complications included ischemia of the lower leg in 4 patients,peroneal nerve palsy in 12 patients (permanent palsy in 9 patients and temporary palsy in 3 patients),wound healing problem in 4 patients,deep infection in 1 patient,and periprosthetic fracture in 1 patient.The mean MSTS 93 score was 21.6 points (72％).Conculusion The indications of limb salvage surgery for malignant tumors of the proximal tibia involving the fibula should be restricted.Although complications are encountered frequently,most patients have acceptable postoperative function. Key words: Tibia; Fibula; Bone neoplasms; Extremities; Salvage therapy