Main Article Content
Ewing’s sarcoma, humerus diaphysis, epiphysis proximally, Reconstruction, vascularized fibula epiphyseal transfer
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 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 (Figure 1).
2. Taylor GI, Wilson KR, Rees MD, Corlett RJ and Cole WG. The anterior tibial vessels and their role in epiphyseal and diaphyseal transfer of the fibula: experimental study and clinical applications. Brit J Plast Surg. 1988 Sept 1;41(5):451–69.
3. Tsai TM, Ludwig L and Tonkin M. Vascularized fibular epiphyseal transfer: a clinical study. Clin Orthop Relat R. 1986 Sept 1;210:228–34.
4. Pho RW, Patterson MH, Kour AK and Kumar VP. Free vascularised epiphyseal transplantation in upper extremity reconstruction. J Hand Surg-Brit Eur. 1988 Nov 1;13:440–47.
5. Trueta J and Morgan JD. The vascular contribution to osteogenesis I: studies by the injection method. J Bone Joint Surg Br. 1960 Feb 1;42b:97–109.
6. Trueta J and Little K. The vascular contribution to osteogenesis II: studies with the electron microscope. J Bone Joint Surg Br. 1960 May 1;42B:367–76.
7. Menezes-Leite MC, Dautel G, Duteille F and Lascombes P. Transplantation of the proximal fibula based on the anterior tibial artery: anatomical study and clinical application. Surg Radiol Anat. 2000 Jan 1 22(5–6):235–38.
8. Innocenti M, Baldrighi C and Menichini G. Long term results of epiphyseal transplant in distal radius reconstruction in children. Handchir Mikrochir P. 2015 Apr 21;47(2):83–89.
9. Innocenti M, Delcroix L, Romano GF and Capanna R. Vascularized epiphyseal transplant. Orthop Clin N Am. 2007 Jan 1;38(1):95–101.
10. Yang J, Qin B, Li P, Fu G, Xiang J and Gu L. Vascularized proximal fibular epiphyseal transfer for Bayne and Klug type III radial longitudinal deficiency in children. Plast Reconstr Surg. 2015 Jan 1;135(1):157e–166e.