Background:
Telangiectatic osteosarcoma is a rare, aggressive malignancy in paediatric patients, often requiring extensive resection and resulting in significant bony defects. Vascularised fibular grafts are a method of restoring skeletal stability and facilitating bone healing after such procedures. This case report aims to illustrate the distinctive use of a vascularised fibular graft for iliofemoral arthrodesis in a patient with ischial tuberosity osteosarcoma.
Methods:
A 14-year-old male with ischial tuberosity osteosarcoma underwent a type 2/3 internal hemipelvectomy. Following tumour resection, a contralateral 20 cm vascularized fibula graft was harvested. A unique surgical technique was used where the fibula was split in two segments while maintaining a single vascular supply. The graft was rotated 50° to attach from the pubic ramus to the ASIS and femur. Microvascular anastomosis was performed using the peroneal artery and a branch of the superficial femoral artery. Postoperative management included radiographic imaging and clinical evaluations.
Results:
The patient had an estimated intraoperative blood loss of 5L necessitating significant blood transfusion. A 3-day ICU stay with vasopressor support was required to target a mean arterial pressure of 80 to facilitate flap perfusion. Pain was initially managed with an epidural, followed by a patient-controlled analgesia pump. On postoperative day 4, the patient returned to theatre for a wound check and drain removal. Surgical margins were clear on macroscopic examination. The patient remained neurovascularly intact distally, retaining ankle full motion (70°). At 1 week post op VAS pain score was 1. Early post-operative imaging showed stable graft position. Functional recovery and bony union continue to be followed up.
Conclusion:
This case demonstrates the distinctive use of a vascularised fibula graft for iliofemoral arthrodesis following a Type 2/3 internal hemipelvectomy in a paediatric patient. The graft’s rotation provided increased skeletal stability, and early results suggest successful surgical technique and postoperative recovery.