Ann Plast Reconstr Surg | Volume 1, Issue 1 | Case Report | Open Access
Paulo Rocha de Pádua Júnior1, Fernando Henrique Novaes1, Aline Pacheco de Rezende1, José Antônio Cezaretti1 and Guilherme Cardinali Barreiro1,2*
1Division of Plastic and Reconstructive Surgery, The Institute of the Public Server’s Health, Brazil
2Division of Plastic and Reconstructive Surgery, The State University of Campinas, Brazil
*Correspondance to: Guilherme Cardinali Barreiro
Fulltext PDFIntroduction: Defects originated from oncologic bone resections can compromise function, especially in weight bearing areas such as the foot, ultimately impairing gait and movement. Reconstruction of a metatarsal bone resection can be performed with bone grafts or flaps, either pedicled or free vascularized. We present a salvage reconstruction with an original reverse osteomyocutaneous medial tibia flap (ROMT), after a failed fibula graft for a first metatarsal chondrosarcoma resection. This is the first report of the use of this flap.
Case Report: Thirty-five year old male patient, who underwent reconstruction with an ipsilateral fibula bone graft, after tumor resection of the first right metatarsal bone by the oncology orthopedics team. On follow up, he presented bone graft necrosis, infection and wound dehiscence. Debridement of the graft and wound bed left a complex defect comprising bone and soft tissue on the medial aspect of the foot. We designed the ROMT based on the posterior tibial vessels and safenous vein for the reconstruction. The safenous vein was included to improve venous drainage of the reverse flap. The flap included a 15 cm × 4 cm wedge of cortical and cancellous bone from the proximal medial aspect of the tibia, and the overlying muscle, subcutaneous and skin. Donor site was primarily closed. The patient walked in partial weight bearing with crutches for 2 months. On follow up 10 months the patient presents normal gait, with complete reossification of the donor site.
Conclusion: In the case presented, the ROMT was a safe alternative for complex reconstruction of the foot and presented low donor site morbidity with satisfactory functional recovery. This original flap may be an option for pedicled reconstructions of the foot and distal part of the lower extremity, or even as a free flap for complex reconstructions in other segments of the body.
Chondrosarcoma; Reverse osteomyocutaneous medial tibia flap; Vascularized tibia flap; Foot reconstruction; Pedicled flap; Reverse pedicled flap
de Pádua Júnior PR, Novaes FH, de Rezende AP, Cezaretti JA, Barreiro GC. Reverse Osteomyocutaneous Medial Tibia Flap for Complex Midfoot Reconstruction: Case Report. Ann Plast Reconstr Surg. 2017;1(1):1005.