Search

In patients with primary calcaneal malignancies, such as Ewing's sarcoma, radical treatment with amputation of the foot can result in serious functional impairment and chronic pain. Total calcanectomy followed by the reconstruction of the calcaneal defect offers an alternative treatment to amputation. Capanna et al. described a technique for successfully reconstructing long limb segmental bone defects using a free fibula flap placed within the intramedullary canal of an allograft. We present both a review of the literature on calcaneal reconstruction and describe how the principles of Capanna can be adapted to reconstruct the calcaneus. Total calcanectomy due to Ewing's sarcoma and the subsequent application of this novel reconstructive technique was performed in two young patients aged 5 and 16 years. The reconstruction was achieved by inserting a distally pedicled osteocutaneous fibula flap within the reamed canal of an allograft and placing the composite in the calcaneal defect. Reconstruction was successful with complete bone union between the allograft and the adjacent bone. There were no fractures or infections and both flaps survived. Functional outcome was assessed with a physiotherapist at a follow-up period of 2 years postoperatively, showing near-normal ambulance. This novel technique proved excellent as a limb salvage procedure, avoiding amputation, and offering a satisfactory oncological and functional outcome., Competing Interests: Conflict of Interest The authors have nothing to disclose., (Copyright © 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: In 2015, we published one of the first reports using an enhanced recovery protocol (ERP) in microsurgery 1 , and in 2016, our final ERP setup in autologous breast reconstruction (ABR) using free abdominal flaps 2 . We showed that by adhering to a few simple, easy to measure, functional discharge criteria, it was possible to safely discharge the patients by the third postoperative day (POD). However, one of the challenges of interpreting studies using ERP in ABR is the often heterogenous patient populations and the need to clearly distinguish between primary and secondary and unilateral and bilateral reconstructions., Materials and Methods: In the 5-year period from 2016-2020, the same surgical team, performed 147 unilateral, delayed breast reconstructions (135 DIEP, 9 MS-TRAM-2, and 3 SIEA flaps) according to our previous analgesic protocol and surgical strategy. Data were collected prospectively., Results: Three flaps were lost (2%) and 82% of the patients(n=128) were discharged to home by POD 2 (n=8%) or 3 (74%). The remaining 18% (n=26) were discharged by POD 4 (12.5%) or 5 (5.5%). Ten patients (7%) were reoperated, and 17 patients (12%) had minor complications within POD 30 (infection, seroma, etc.) that did not necessitate hospital admission., Conclusion: Using our ERP, unproblematic discharge directly to home is possible on POD 3 in more than 80% of patients after ABR. ERP is no longer a research tool but considered standard of care in microsurgical breast reconstruction., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Transfer of a vascularised free fibular bone for reconstruction of the cervical spine has been described previously.(1-4) However, this is the first report of a reconstruction with both an osteocutaneous fibular flap for anterior stabilisation and a double-islanded osteocutaneous fibular flap for posterior stability. We present a case of an osteoclastoma in C2 initially treated with radiotherapy 1.8 Gy × 30. Two months after radiotherapy, the patient developed severe osteoradionecrosis and luxation of C2 causing neurological impairment. The patient was treated with cervical traction for 10 days. Resection of C2 was performed through a posterior approach and a secondary transoral approach. The spine was stabilised from a posterior approach using allografts and a titanium plate and rod construct (Vertex) from the occipital squama to C5 and from an anterior approach with allograft filled cage from C1 to C3. Two months later, rupture of the pharyngeal wall was noted with exposure of the anterior cage. A few days later, the posterior scar ruptured. The anterior cage was removed and the pharyngeal wall was sutured. Revision of the posterior wound was performed, leaving the implants in place. To secure stability of the spine, the patient was treated with a HALO. Once again, the pharyngeal wall ruptured. Reconstruction of the posterior pharyngeal wall and the anterior column of the spine was performed with an osteocutaneous fibular flap from the skull base to C3. Five months later, a computed tomography (CT) scan showed insufficient bony fusion of both anterior and posterior bone grafts, and the posterior wound had not healed. A second osteocutaneous fibular flap was placed bilaterally from the occipital squama to the posterior elements of Th1, closing the wound defect. Apart from the occipital squama, fusion was seen at all sites after 14 months, and the HALO was removed., (Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)