Ipsilateral pedicled fibular flap for tibial reconstruction after Ewing sarcoma resection

Ewing sarcoma is a rare and lethal malignant bone tumor, mostly affecting young male patients, and has a predilection for the femur, tibia, pelvis, and humerus. Based on the use of improved staging systems, chemotherapy, radiation, and resective surgery, actually most patients live and retain function of their limbs. The concept of limb-sparing surgery has evolved over the last three decades and has become as effective as amputation in treating extremity sarcoma. Many centers have abandoned traditional reconstruction with avascular allografts, resection arthrodesis in favor of metallic endoprosthesis, or fibula free flap for long bone defects. The ipsilateral fibular pedicled flap is an excellent choice for tibial, large, segmental defects reconstruction, because it has a low rate of infection and malunion; the functional outcome is good and avoids contralateral donor site morbidity, and it is less time-consuming than free fibula flap. It also provides the advantage of one-stage reconstruction. We report a case of a 12-year-old patient with history of Ewing sarcoma on the 1/3 of the upper tibia. The bone defect after tumor excision was 12 cm; the flap was dissected until the vascular pedicle, rotated to 180°, and fixed with plate in T and screws. The patient had successful bone union and achieved good functional results at the end of the 1-year follow-up period. Full weight-bearing was achieved within 7 months. This technique should be considered for reconstructing large and complex bone defects resulting from tumor extirpation.